Provider Demographics
NPI:1225364318
Name:BETO, TRAVIS STEVEN (DIPL OM)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:STEVEN
Last Name:BETO
Suffix:
Gender:M
Credentials:DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 LINCOLN RD
Mailing Address - Street 2:STE 302
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2904
Mailing Address - Country:US
Mailing Address - Phone:305-439-7811
Mailing Address - Fax:305-531-2575
Practice Address - Street 1:628 SANTANDER AVE
Practice Address - Street 2:#6
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6540
Practice Address - Country:US
Practice Address - Phone:305-439-7811
Practice Address - Fax:305-531-2575
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2761171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist