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Organization
JOSEPH D BETTENCOURT MD INC
Active
Organization
JOSEPH D BETTENCOURT MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH D BETTENCOURT MD (PRESIDENT)
(805) 434-2240
Entity
Organization
Contact information
Practice address
2120 GOLDEN HILL RD, SUITE 202, PASO ROBLES, CA 93446
(805) 434-2240
(805) 434-0102
Mailing address
2120 GOLDEN HILL RD, SUITE 202, PASO ROBLES, CA 93446
(805) 434-2240
(805) 434-0102
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A67264
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0973925
CLIA WAIVED CERTIFICATE NUMBER
CA
01
—
10610
CITY OF PASO ROBLES BUSINESS LICENSE
CA
01
—
C3356037
SECRETARY OF STATE-DEPT OF CORPORATIONS NUMBER
CA
01
—
CLR326953
CLIA STATE REGISTRATION NUMBER
CA
Enumeration date
08/24/2011
Last updated
09/26/2023
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