Provider Demographics
NPI:1922039288
Name:BETETA, FERNANDO (DC)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:BETETA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5582 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5514
Mailing Address - Country:US
Mailing Address - Phone:310-398-0888
Mailing Address - Fax:310-313-5872
Practice Address - Street 1:5582 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-5514
Practice Address - Country:US
Practice Address - Phone:310-398-0888
Practice Address - Fax:310-313-5872
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18288Medicare ID - Type Unspecified