MEDICARE: ISABEL CRISTINA BETANCOURT-GOMEZ 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	208000000X	Pediatrics Physician	12310	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20051	OTHER	PR	SSS

General Provider Information

NPI Number	:	1841294667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABEL CRISTINA BETANCOURT-GOMEZ M.D.

Provider Business Mailing Address
First Line	:	PMB 493
Second Line	:	PO BOX 70344
City	:	SAN JUAN
State	:	PR
Zip	:	00936-8344
Country	:	US
Telephone Number	:	787-751-6210
Fax Number	:

Provider Business Practice Location Address
First Line	:	EL MONTE MALL SHOPPING CENTER SUITE 3225
Second Line	:	652 AVE MUNOZ-RIVERA
City	:	SAN JUAN
State	:	PR
Zip	:	00918
Country	:	US
Telephone Number	:	787-751-6210
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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Directions to “ ISABEL CRISTINA BETANCOURT-GOMEZ M.D.” Practice Location

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