Provider Demographics
NPI:1366154973
Name:BETANCOURT GAZTAMBIDE, JEANLOUIS (PHARMD)
Entity type:Individual
Prefix:
First Name:JEANLOUIS
Middle Name:
Last Name:BETANCOURT GAZTAMBIDE
Suffix:
Gender:M
Credentials:PHARMD
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 9030
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960
Mailing Address - Country:US
Mailing Address - Phone:787-925-5233
Mailing Address - Fax:
Practice Address - Street 1:VA CARIBBEAN HEALTHCARE SYSTEM
Practice Address - Street 2:10 CASIA STREET
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-834-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2710390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program