Healthcare Provider Details

I. General information

NPI: 1386325108
Provider Name (Legal Business Name): KARIN HIRALDO BETANCOURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 E VINE ST
KISSIMMEE FL
34744-3730
US

IV. Provider business mailing address

3218 ZANDER DR APT 304
KISSIMMEE FL
34747-1155
US

V. Phone/Fax

Practice location:
  • Phone: 407-847-4152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: