Provider Demographics
NPI:1780779371
Name:BETANCOURT, NELHS (MD, MPH, DABT)
Entity type:Individual
Prefix:DR
First Name:NELHS
Middle Name:
Last Name:BETANCOURT
Suffix:
Gender:M
Credentials:MD, MPH, DABT
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:NELLIE
Other - Last Name:BETANCOURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:770 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 2K
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3120
Mailing Address - Country:US
Mailing Address - Phone:951-898-6600
Mailing Address - Fax:951-898-7647
Practice Address - Street 1:770 MAGNOLIA AVE
Practice Address - Street 2:SUITE 2K
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3120
Practice Address - Country:US
Practice Address - Phone:951-898-6600
Practice Address - Fax:951-898-7647
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71771207R00000X, 2083T0002X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
EO9378Medicare UPIN