Provider Demographics
NPI:1629733258
Name:BELTRAN, BERLIN BRIANNA
Entity Type:Individual
Prefix:
First Name:BERLIN
Middle Name:BRIANNA
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 1:1343 CAMINITO BALADA
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7184
Mailing Address - Country:US
Mailing Address - Phone:818-983-2183
Mailing Address - Fax:
Practice Address - Street 1:1343 CAMINITO BALADA
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-7184
Practice Address - Country:US
Practice Address - Phone:818-983-2183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95264654163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse