Healthcare Provider Details

I. General information

NPI: 1629031679
Provider Name (Legal Business Name): BETANIA REYES MATOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 FUTURES DR STE 9
ORLANDO FL
32819-9076
US

IV. Provider business mailing address

6675 WESTWOOD BLVD STE 475
ORLANDO FL
32821-6027
US

V. Phone/Fax

Practice location:
  • Phone: 407-240-2361
  • Fax: 407-345-8895
Mailing address:
  • Phone: 407-845-0330
  • Fax: 888-972-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: