Doctor Name: | PETRA BETANCOURT |
NPI Number: | 1194900027 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 11565 Laurel Canyon Blvd. Suite #116 Mission Hills, CA - 91430 |
Business Phone Number: | 8183615030 |
Business Fax Number: | 8183611764 |
Mailing Address: | 4117 Mclaughlin Ave Apt 2, LOS ANGELES |
State: | CA |
Postal Code: | 900665447 |
Phone Number: | 3108692482 |
Fax Number: | |
NPI Enumeration Date: | 01/09/2008 |
NPI Last Update Date: | 04/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Rehabilitation Practitioner |
Taxonomy Specialization: | |
Taxonomy Definition: | A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. |