Provider Demographics
NPI:1053205484
Name:MEDINA, BETZAIDA
Entity type:Individual
Prefix:
First Name:BETZAIDA
Middle Name:
Last Name:MEDINA
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:PO BOX 420985
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34742-0985
Mailing Address - Country:US
Mailing Address - Phone:787-553-7856
Mailing Address - Fax:787-553-7856
Practice Address - Street 1:PO BOX 420985
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34742-0985
Practice Address - Country:US
Practice Address - Phone:787-553-7856
Practice Address - Fax:787-553-7856
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-439614103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst