Provider Demographics
NPI:1518127604
Name:BELTRAN, AGATHA (DC)
Entity Type:Individual
Prefix:
First Name:AGATHA
Middle Name:
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S VERDUGO RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1424
Mailing Address - Country:US
Mailing Address - Phone:818-459-0569
Mailing Address - Fax:818-545-0793
Practice Address - Street 1:203 S VERDUGO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1424
Practice Address - Country:US
Practice Address - Phone:818-459-0569
Practice Address - Fax:818-545-0793
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor