Basic Information
| Provider Information | |||||||||
| NPI: | 1851533749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELTRAN | ||||||||
| FirstName: | MANUEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 688 | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932750688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596887531 | ||||||||
| FaxNumber: | 5596883509 | ||||||||
| Practice Location | |||||||||
| Address1: | 559 E BARDSLEY AVE | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932745400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596887531 | ||||||||
| FaxNumber: | 5596883509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2009 | ||||||||
| LastUpdateDate: | 03/24/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 332 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.