Provider Demographics
NPI:1679328199
Name:BETANCOURT, INES (CHW)
Entity type:Individual
Prefix:
First Name:INES
Middle Name:
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 N LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-3006
Mailing Address - Country:US
Mailing Address - Phone:503-988-5090
Mailing Address - Fax:503-988-5305
Practice Address - Street 1:9000 N LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-3006
Practice Address - Country:US
Practice Address - Phone:503-988-5090
Practice Address - Fax:503-988-5305
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000105016172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker