Provider Demographics
NPI:1407234503
Name:BELTRAN, KATHLEEN (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:BELTRAN
Other - Last Name:DIMACUHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1855 CORPORAL KENNEDY ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1436
Mailing Address - Country:US
Mailing Address - Phone:718-410-3400
Mailing Address - Fax:718-410-4643
Practice Address - Street 1:1030 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-6100
Practice Address - Country:US
Practice Address - Phone:718-410-3400
Practice Address - Fax:718-410-4643
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339553-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily