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General NPI Number Information
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NPI Number | 1437410230
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Entity Type | Individual
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Provider Name | BETSY COODUVALLI DO
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Gender | Female
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 500 N WASHINGTON AVE STE 109
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City | TITUSVILLE
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State | FL
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Zip | 32796
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Country | US
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Telephone | 321-768-1600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 690609
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City | ORLANDO
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State | FL
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Zip | 32869-0609
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Country | US
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Telephone | 407-846-7546
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Fax | 321-206-5419
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | OS10726
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License Number State | FL
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