Provider Demographics
NPI:1174845952
Name:BELTRAN MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:BELTRAN MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IDALMIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA-PORBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-551-2165
Mailing Address - Street 1:14223 SW 42 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI DADE
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6408
Mailing Address - Country:US
Mailing Address - Phone:305-551-2165
Mailing Address - Fax:305-551-2167
Practice Address - Street 1:14223 SW 42 ST
Practice Address - Street 2:
Practice Address - City:MIAMI DADE
Practice Address - State:FL
Practice Address - Zip Code:33175-6408
Practice Address - Country:US
Practice Address - Phone:305-551-2165
Practice Address - Fax:305-551-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88244207Q00000X
FLME91105208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty