Provider Demographics
NPI:1942188388
Name:BETANCOURT CAMPOS, RUBEN (BA IN PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:BETANCOURT CAMPOS
Suffix:
Gender:M
Credentials:BA IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 N BROADWAY APT 15
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-3131
Mailing Address - Country:US
Mailing Address - Phone:805-406-6189
Mailing Address - Fax:
Practice Address - Street 1:700 VICKIE AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-2236
Practice Address - Country:US
Practice Address - Phone:805-361-7753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADB6F86480F171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach