| Joseph D Bettencourt Md Inc | |
|
2120 Golden Hill Rd Suite 202 Paso Robles CA 93446 | |
| (805) 434-2240 | |
| (805) 434-0102 |
| Full Name | Joseph D Bettencourt Md Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2120 Golden Hill Rd, Paso Robles, California |
| Authorized Official Name and Position | Joseph D Bettencourt (PRESIDENT) |
| Authorized Official Contact | 8054342240 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Joseph D Bettencourt Md Inc 2120 Golden Hill Rd Suite 202 Paso Robles CA 93446 Ph: (805) 434-2240 | Joseph D Bettencourt Md Inc 2120 Golden Hill Rd Suite 202 Paso Robles CA 93446 Ph: (805) 434-2240 |
| NPI Number | 1386924249 |
|---|---|
| Provider Enumeration Date | 08/24/2011 |
| Last Update Date | 09/26/2023 |
| Medicare PECOS PAC ID | 8527239102 |
|---|---|
| Medicare Enrollment ID | O20110913000269 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386924249 | NPI | - | NPPES |
| 05D0973925 | Other | CA | CLIA WAIVED CERTIFICATE NUMBER |
| 10610 | Other | CA | CITY OF PASO ROBLES BUSINESS LICENSE |
| C3356037 | Other | CA | SECRETARY OF STATE-DEPT OF CORPORATIONS NUMBER |
| CLR326953 | Other | CA | CLIA STATE REGISTRATION NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A67264 (California) | Primary |
| Provider Name | Joseph D Bettencourt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396796215 PECOS PAC ID: 4385787365 Enrollment ID: I20100201000006 |
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