MEDICARE: DR. BENJAMIN BETANCOURT M.D.

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	207RC0000X	Cardiovascular Disease Physician	3679	PR

General Provider Information

NPI Number	:	1710977624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN BETANCOURT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 19356
Second Line	:	FERNADEZ JUNCOS STATION
City	:	SAN JUAN
State	:	PR
Zip	:	00910-1356
Country	:	US
Telephone Number	:	787-728-7240
Fax Number	:	787-727-2892

Provider Business Practice Location Address
First Line	:	FERNADEZ JUNCOS AVE. 1501
Second Line	:	SUITE 401 BETANCOURT BUILDING
City	:	SANTURCE
State	:	PR
Zip	:	00910
Country	:	US
Telephone Number	:	787-728-7240
Fax Number	:	787-727-2892

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	08/16/2021

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