MEDICARE: ENDER JESUS BETANCOURT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		CA
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1629660311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENDER JESUS BETANCOURT

Provider Business Mailing Address
First Line	:	1891 EFFIE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-1711
Country	:	US
Telephone Number	:	213-908-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1891 EFFIE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-1711
Country	:	US
Telephone Number	:	213-908-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2021
Last Update Date	:	02/18/2026

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Directions to “ ENDER JESUS BETANCOURT ” Practice Location

Language	Start Address	Practice Location

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