Provider Demographics
NPI:1013227529
Name:BETANCOURT, ELIAS
Entity Type:Individual
Prefix:MR
First Name:ELIAS
Middle Name:
Last Name:BETANCOURT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SANTIAGO IGLESIAS
Mailing Address - Street 2:
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723
Mailing Address - Country:UM
Mailing Address - Phone:787-374-0106
Mailing Address - Fax:
Practice Address - Street 1:17 CALLE SANTIAGO IGLESIAS
Practice Address - Street 2:
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723-2603
Practice Address - Country:US
Practice Address - Phone:787-374-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR595247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other