Provider Demographics
NPI:1730157140
Name:BETANCOURT, EMILIO SR (MD)
Entity type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:
Last Name:BETANCOURT
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1387
Mailing Address - Country:US
Mailing Address - Phone:787-758-5660
Mailing Address - Fax:787-763-5760
Practice Address - Street 1:369 AVE DE DIEGO
Practice Address - Street 2:TORRE SAN FRANCISCO STE 403
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-758-5660
Practice Address - Fax:787-763-5760
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7312208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics