Provider Demographics
NPI:1972000578
Name:BETTENCOURT, CECILIA MARINA (DC)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:MARINA
Last Name:BETTENCOURT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13241 ANAWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-1706
Mailing Address - Country:US
Mailing Address - Phone:775-848-0838
Mailing Address - Fax:
Practice Address - Street 1:1026 E CHAPMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2150
Practice Address - Country:US
Practice Address - Phone:714-633-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor