Basic Information
| Provider Information | |||||||||
| NPI: | 1184608747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELTRAN | ||||||||
| FirstName: | ELEANOR | ||||||||
| MiddleName: | MARIANO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7675 MADISON ST NE | ||||||||
| Address2: | |||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554322753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637854500 | ||||||||
| FaxNumber: | 7637853314 | ||||||||
| Practice Location | |||||||||
| Address1: | 7675 MADISON ST NE | ||||||||
| Address2: | |||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554322753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637854500 | ||||||||
| FaxNumber: | 7637853314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 37073 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.