Provider Demographics
NPI:1598795791
Name:BETTENCOURT, HUI (PA)
Entity Type:Individual
Prefix:
First Name:HUI
Middle Name:
Last Name:BETTENCOURT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 S WHITE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2071
Mailing Address - Country:US
Mailing Address - Phone:408-729-4290
Mailing Address - Fax:
Practice Address - Street 1:2880 STORY RD
Practice Address - Street 2:SUITE 10
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-3942
Practice Address - Country:US
Practice Address - Phone:408-729-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 18319363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551869Medicare PIN