Individual
BETANIA REYES MATOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8803 FUTURES DR STE 9, ORLANDO, FL 32819-9076
(407) 240-2361
(407) 345-8895
Mailing address
6675 WESTWOOD BLVD STE 475, ORLANDO, FL 32821-6027
(407) 845-0330
(888) 972-1752
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ACN612
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014084800
—
FL
01
—
612
FLORIDA ACN
FL
01
—
IC109Z
MEDICARE PTAN
FL
Enumeration date
04/10/2006
Last updated
06/01/2023
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