Provider Demographics
NPI:1922755867
Name:BELTRAN, LUIS MANUEL
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:MANUEL
Last Name:BELTRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8817 NW 145TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-8018
Mailing Address - Country:US
Mailing Address - Phone:305-409-9779
Mailing Address - Fax:
Practice Address - Street 1:8817 NW 145TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018-8018
Practice Address - Country:US
Practice Address - Phone:305-409-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician