Provider Demographics
NPI:1205046786
Name:PEREZ- BETANCOURT MEDICAL, P.S.C
Entity type:Organization
Organization Name:PEREZ- BETANCOURT MEDICAL, P.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ-CHIESA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-761-2305
Mailing Address - Street 1:PMB 381 220 WESTERN AUTO PLAZA
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-3606
Mailing Address - Country:US
Mailing Address - Phone:787-761-2305
Mailing Address - Fax:787-761-1895
Practice Address - Street 1:CARR. 848 KM 0.0
Practice Address - Street 2:CENTRO -4 PLAZA SUITE 202
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-761-2305
Practice Address - Fax:787-761-1895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR79632080P0214X
PR56932084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085517Medicare PIN
PRF61232Medicare UPIN