Provider Demographics
NPI:1639440142
Name:BETECH, AVIVA (IMF)
Entity Type:Individual
Prefix:
First Name:AVIVA
Middle Name:
Last Name:BETECH
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 EL CAJON BLVD
Mailing Address - Street 2:SUITE210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4450
Mailing Address - Country:US
Mailing Address - Phone:619-640-3266
Mailing Address - Fax:619-640-3269
Practice Address - Street 1:4660 EL CAJON BLVD
Practice Address - Street 2:SUITE210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4450
Practice Address - Country:US
Practice Address - Phone:619-640-3266
Practice Address - Fax:619-640-3269
Is Sole Proprietor?:No
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program