Provider Demographics
NPI:1114584794
Name:BELTRAN, MARTINA EVETTE
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:EVETTE
Last Name:BELTRAN
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 1:6210 75TH ST W STE B100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8109
Mailing Address - Country:US
Mailing Address - Phone:253-345-5720
Mailing Address - Fax:
Practice Address - Street 1:6210 75TH ST W STE B100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8109
Practice Address - Country:US
Practice Address - Phone:253-345-5720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician