Provider Demographics
NPI:1972768737
Name:BETAIN PROFESSIONAL CENTER, INC
Entity Type:Organization
Organization Name:BETAIN PROFESSIONAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:VIZCAINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-447-5690
Mailing Address - Street 1:3900 NW 79TH AVE
Mailing Address - Street 2:SUITE 587
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6556
Mailing Address - Country:US
Mailing Address - Phone:786-447-5690
Mailing Address - Fax:
Practice Address - Street 1:3900 NW 79TH AVE
Practice Address - Street 2:SUITE 587
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6556
Practice Address - Country:US
Practice Address - Phone:786-447-5690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization