Provider Demographics
NPI:1730654930
Name:BETANCOURT, YOKASTA JOHANNA
Entity Type:Individual
Prefix:
First Name:YOKASTA
Middle Name:JOHANNA
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 HILLMAN AVE APT 6E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3081
Mailing Address - Country:US
Mailing Address - Phone:347-751-8808
Mailing Address - Fax:
Practice Address - Street 1:3960 HILLMAN AVE APT 6E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3081
Practice Address - Country:US
Practice Address - Phone:347-751-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist