Provider Demographics
NPI:1760116628
Name:LOPEZ CONSUEGRA, ANA BETSY
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:BETSY
Last Name:LOPEZ CONSUEGRA
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 1:14057 BRIARDALE LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2218
Mailing Address - Country:US
Mailing Address - Phone:727-383-7306
Mailing Address - Fax:
Practice Address - Street 1:14057 BRIARDALE LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2218
Practice Address - Country:US
Practice Address - Phone:727-383-7306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist