Provider Demographics
NPI:1184405185
Name:BETANCOURT, CHRISTIAN SR (BSN)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:
Last Name:BETANCOURT
Suffix:SR
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB.SUNVILLE CALLE-18 Y-14 TRUJILLO ALTO P.R 00976
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-220-9159
Mailing Address - Fax:
Practice Address - Street 1:URB.SUNVILLE
Practice Address - Street 2:CALLE-18 Y-14
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-220-9159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRG85004163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse