Active NPI
Maria I Betancourt, PA
- Physician Assistant
- Sacramento, CA
National Provider Identifier
1386854677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA10412
- Practice address
- 5385 Franklin Blvd Ste K
Sacramento, CA 95820-4717 - Phone
- (916) 428-0656
- NPI assigned
- May 23, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10412 | CA | Primary |
Addresses
Primary practice location
5385 Franklin Blvd Ste K
Sacramento, CA 95820-4717
Mailing address
5385 Franklin Blvd Ste K
Sacramento, CA 95820-4717
Phone (916) 428-0656
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA10412 | Other | CA | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247788800000",
"number": "1386854677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5385 FRANKLIN BLVD STE K",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958204717",
"telephone_number": "916-428-0656",
"fax_number": "916-428-3763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5385 FRANKLIN BLVD STE K",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958204717",
"telephone_number": "916-428-0656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BETANCOURT",
"first_name": "MARIA",
"middle_name": "I",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-23",
"last_updated": "2009-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA10412",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "PA10412",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.