Provider Demographics
NPI:1801606264
Name:BETANCIO, LIZBET
Entity type:Individual
Prefix:
First Name:LIZBET
Middle Name:
Last Name:BETANCIO
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 1:26297 BASELINE ST SPC 2
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-2833
Mailing Address - Country:US
Mailing Address - Phone:951-858-5326
Mailing Address - Fax:
Practice Address - Street 1:26297 BASELINE ST SPC 2
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-2833
Practice Address - Country:US
Practice Address - Phone:951-858-5326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17941101YM0800X
CA150248101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health