Provider Demographics
NPI:1730645425
Name:WINTERMUTE, BETZABE SONALY (SA-C)
Entity Type:Individual
Prefix:
First Name:BETZABE
Middle Name:SONALY
Last Name:WINTERMUTE
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29019 SHADOW VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-1290
Mailing Address - Country:US
Mailing Address - Phone:661-373-7193
Mailing Address - Fax:
Practice Address - Street 1:29019 SHADOW VALLEY LN
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91390-1290
Practice Address - Country:US
Practice Address - Phone:661-373-7193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17-130246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant