Provider Demographics
NPI:1659547123
Name:ANGEL A BETANCOURT MD PA
Entity Type:Organization
Organization Name:ANGEL A BETANCOURT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:ALFONSO
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-663-1266
Mailing Address - Street 1:6705 S RED RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3622
Mailing Address - Country:US
Mailing Address - Phone:305-663-1266
Mailing Address - Fax:305-663-8928
Practice Address - Street 1:6705 S RED RD
Practice Address - Street 2:SUITE 510
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-3622
Practice Address - Country:US
Practice Address - Phone:305-663-1266
Practice Address - Fax:305-663-8928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 91344174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty