Provider Demographics
NPI:1144804766
Name:BELTRAN, TONANTZYN
Entity Type:Individual
Prefix:
First Name:TONANTZYN
Middle Name:
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 1:54 SIR FRANCIS DRAKE BLVD # A
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2536
Mailing Address - Country:US
Mailing Address - Phone:415-524-6850
Mailing Address - Fax:
Practice Address - Street 1:54 SIR FRANCIS DRAKE BLVD # A
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2536
Practice Address - Country:US
Practice Address - Phone:415-524-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)