Provider Demographics
NPI:1144192857
Name:PEREZ MORA, BETZAIDA FABIANA
Entity type:Individual
Prefix:
First Name:BETZAIDA
Middle Name:FABIANA
Last Name:PEREZ MORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5449 S SEMORAN BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1779
Mailing Address - Country:US
Mailing Address - Phone:321-438-3688
Mailing Address - Fax:
Practice Address - Street 1:5449 S SEMORAN BLVD STE 213
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1779
Practice Address - Country:US
Practice Address - Phone:321-438-3688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP632975835000343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)