Provider Demographics
NPI:1376831248
Name:CABRERA BETANCOURT, EDGAR
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:
Last Name:CABRERA BETANCOURT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SENIORS
Other - Middle Name:
Other - Last Name:CITA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:220 PLAZA WESTERN AUTO
Mailing Address - Street 2:412 SUITE 101
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-3606
Mailing Address - Country:US
Mailing Address - Phone:787-645-3030
Mailing Address - Fax:787-761-5634
Practice Address - Street 1:CARRETERA 845 KM 5.8
Practice Address - Street 2:CAMINO PABLO ORTIZ
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-3606
Practice Address - Country:US
Practice Address - Phone:787-645-3030
Practice Address - Fax:787-761-5634
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)