Provider Demographics
NPI:1811577273
Name:BELTRAN LARA, IVONNE LILIAN (MD)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:LILIAN
Last Name:BELTRAN LARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 NE THORNTON PL
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-8021
Mailing Address - Country:US
Mailing Address - Phone:206-520-2405
Mailing Address - Fax:
Practice Address - Street 1:331 NE THORNTON PL
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-8021
Practice Address - Country:US
Practice Address - Phone:206-520-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program