MEDICARE: MRS. ANNETTE M BETANCOURT DEL VALLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA12498	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831438738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNETTE M BETANCOURT DEL VALLE

Provider Business Mailing Address
First Line	:	10300 SW 72ND STREET
Second Line	:	SUITE 358
City	:	MIAMI
State	:	FL
Zip	:	33173-3029
Country	:	US
Telephone Number	:	786-553-7032
Fax Number	:

Provider Business Practice Location Address
First Line	:	10300 SW 72ND ST STE 358
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3020
Country	:	US
Telephone Number	:	786-313-3541
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2013
Last Update Date	:	07/21/2022

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