Provider Demographics
NPI:1992463426
Name:BETTIN, ABRAHAM MORRIS (RN)
Entity type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:MORRIS
Last Name:BETTIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MRS
Other - First Name:AHVRAM
Other - Middle Name:M
Other - Last Name:BETTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:4026 MALCOLM AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-5455
Mailing Address - Country:US
Mailing Address - Phone:510-567-3401
Mailing Address - Fax:
Practice Address - Street 1:4026 MALCOLM AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-5455
Practice Address - Country:US
Practice Address - Phone:510-567-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA358657163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse