Provider Demographics
NPI:1851507487
Name:BETANCOURT, SANDRA GARZA (RDN/LD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:GARZA
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:RDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RIO CT
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-2002
Mailing Address - Country:US
Mailing Address - Phone:956-546-4898
Mailing Address - Fax:956-517-1015
Practice Address - Street 1:825 LAKESIDE BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7616
Practice Address - Country:US
Practice Address - Phone:956-546-4898
Practice Address - Fax:956-517-1015
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05843133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150179305Medicaid
331097OtherPTAN