Provider Demographics
NPI:1902393556
Name:BELTRAN, PERLA C
Entity Type:Individual
Prefix:
First Name:PERLA
Middle Name:C
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 1:3632 S RENELLIE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8350
Mailing Address - Country:US
Mailing Address - Phone:813-385-1849
Mailing Address - Fax:
Practice Address - Street 1:3632 S RENELLIE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8350
Practice Address - Country:US
Practice Address - Phone:813-385-1849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy