Provider Demographics
NPI:1639519671
Name:BETANCOURT, KARLA
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:BETANCOURT
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 1:122 N MAGNOLIA AVE
Mailing Address - Street 2:APT 102
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6470
Mailing Address - Country:US
Mailing Address - Phone:915-443-1089
Mailing Address - Fax:
Practice Address - Street 1:122 N MAGNOLIA AVE
Practice Address - Street 2:APT 102
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6470
Practice Address - Country:US
Practice Address - Phone:915-443-1089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator