Provider Demographics
NPI:1982420584
Name:BETANCOURT, LUCAS MIGUEL (PARAMEDIC)
Entity type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:MIGUEL
Last Name:BETANCOURT
Suffix:
Gender:M
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7457 IBIS DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2211
Mailing Address - Country:US
Mailing Address - Phone:727-485-7937
Mailing Address - Fax:
Practice Address - Street 1:7457 IBIS DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2211
Practice Address - Country:US
Practice Address - Phone:727-485-7937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMD545896146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic