Provider Demographics
NPI:1083381388
Name:BELTRAN, LAURA GISSEL (BA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:GISSEL
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E MENLO AVE SPC 42
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-3138
Mailing Address - Country:US
Mailing Address - Phone:951-772-2771
Mailing Address - Fax:
Practice Address - Street 1:1650 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-7402
Practice Address - Country:US
Practice Address - Phone:760-815-5815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician