Provider Demographics
NPI:1053445403
Name:BETANCOURT, NICOLAS R (MD)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:R
Last Name:BETANCOURT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TORRE DE AUXILIO MUTUO 735 PONCE DE LEON
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5024
Mailing Address - Country:US
Mailing Address - Phone:787-767-0655
Mailing Address - Fax:787-767-0655
Practice Address - Street 1:TORRE DE AUXILIO MUTUO 735 PONCE DE LEON
Practice Address - Street 2:SUITE 207
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5024
Practice Address - Country:US
Practice Address - Phone:787-767-0555
Practice Address - Fax:787-767-0655
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR7226207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR066410OtherCRUZ AZUL
PR0400034OtherHUMANA
PR8537OtherIMC
PR29460OtherTRIPLE S
PR29460OtherTRIPLE S
PR0400034OtherHUMANA