Provider Demographics
NPI:1992369755
Name:BELTRAN, EVELYN CLAUDETTE (RPH)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:CLAUDETTE
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-2216
Mailing Address - Country:US
Mailing Address - Phone:323-268-2703
Mailing Address - Fax:323-622-8723
Practice Address - Street 1:3627 E CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-2216
Practice Address - Country:US
Practice Address - Phone:323-268-2703
Practice Address - Fax:323-622-8723
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist