Healthcare Provider Details

I. General information

NPI: 1568320612
Provider Name (Legal Business Name): BETTY MICHELLE SUAREZ LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13309 BEECHBERRY DR # 13309
RIVERVIEW FL
33579-7141
US

IV. Provider business mailing address

13309 BEECHBERRY DR # 13309
RIVERVIEW FL
33579-7141
US

V. Phone/Fax

Practice location:
  • Phone: 305-890-3616
  • Fax:
Mailing address:
  • Phone: 305-890-3616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: