Provider Demographics
NPI:1336858810
Name:LASANTA BELTRAN, FELIX DE JESUS
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:DE JESUS
Last Name:LASANTA BELTRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FELIX
Other - Middle Name:DE JESUS
Other - Last Name:LASANTA BELTRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PMB 162 2 CALLE BARCELO SUITE 201
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794
Mailing Address - Country:US
Mailing Address - Phone:939-273-4114
Mailing Address - Fax:
Practice Address - Street 1:#175 AVE. ALGARROBOS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:939-273-4114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program