Healthcare Provider Details

I. General information

NPI: 1609722180
Provider Name (Legal Business Name): BEATRIZ VALERIA LOPEZ GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CELEBRATION PL STE 302
CELEBRATION FL
34747-5435
US

IV. Provider business mailing address

410 CELEBRATION PL STE 302
CELEBRATION FL
34747-5435
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-4190
  • Fax: 407-303-4192
Mailing address:
  • Phone: 407-303-4190
  • Fax: 407-303-4192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121734
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9121734
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: