Individual
BETSY COODUVALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
500 N WASHINGTON AVE STE 109, TITUSVILLE, FL 32796
(321) 768-1600
Mailing address
PO BOX 690609, ORLANDO, FL 32869-0609
(407) 846-7546
(321) 206-5419
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
OS10726
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14M7E
BCBS
FL
01
—
4583149
CIGNA
FL
Enumeration date
06/07/2012
Last updated
08/15/2019
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