Provider Demographics
NPI:1972090637
Name:BETTENCOURT, CAREN
Entity Type:Individual
Prefix:
First Name:CAREN
Middle Name:
Last Name:BETTENCOURT
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:PO BOX 7877
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0877
Mailing Address - Country:US
Mailing Address - Phone:209-955-2342
Mailing Address - Fax:209-952-5314
Practice Address - Street 1:7590 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-5455
Practice Address - Country:US
Practice Address - Phone:209-955-2342
Practice Address - Fax:209-952-5314
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker