Provider Demographics
NPI:1861003949
Name:BELTRAN, RAUL JUNIOR (NP)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:JUNIOR
Last Name:BELTRAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 E CENTRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5902
Mailing Address - Country:US
Mailing Address - Phone:203-506-8203
Mailing Address - Fax:
Practice Address - Street 1:1612 E CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5902
Practice Address - Country:US
Practice Address - Phone:203-506-8203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008519363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner