Provider Demographics
NPI:1902965841
Name:BETTS, ANDRES (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:
Last Name:BETTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDRES
Other - Middle Name:
Other - Last Name:BETKOWSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:665 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2859
Mailing Address - Country:US
Mailing Address - Phone:949-364-8959
Mailing Address - Fax:949-218-1557
Practice Address - Street 1:665 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2859
Practice Address - Country:US
Practice Address - Phone:949-364-8959
Practice Address - Fax:949-218-1557
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55823207L00000X
CAG56823207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00318531Medicare PIN
CAWG55823AMedicare PIN
CAE74970Medicare UPIN
CAP00318531Medicare PIN