Provider Demographics
NPI:1508352667
Name:RIVERA BETANCOURT, ANTHONY FRANCISCO SR
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:FRANCISCO
Last Name:RIVERA BETANCOURT
Suffix:SR
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:CALLE BARRANQUITAS
Mailing Address - Street 2:516 REPARTO AMERICA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923
Mailing Address - Country:US
Mailing Address - Phone:787-594-0800
Mailing Address - Fax:
Practice Address - Street 1:CALLE BARRANQUITAS
Practice Address - Street 2:516 REPARTO AMERICA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-594-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5076921343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5076921Medicaid