Provider Demographics
NPI:1063178226
Name:BETANCOURT, AIMEE MARGARITA
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:MARGARITA
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13453 NETZLEY PL
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4741
Mailing Address - Country:US
Mailing Address - Phone:909-536-5515
Mailing Address - Fax:
Practice Address - Street 1:6117 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2232
Practice Address - Country:US
Practice Address - Phone:951-481-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty