Provider Demographics
NPI:1063062453
Name:BELTRAN, MICHAEL RODRIGUEZ
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RODRIGUEZ
Last Name:BELTRAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2731 NUGGET AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240-9456
Mailing Address - Country:US
Mailing Address - Phone:341-276-0379
Mailing Address - Fax:
Practice Address - Street 1:14401 SIERRA WAY
Practice Address - Street 2:
Practice Address - City:KERNVILLE
Practice Address - State:CA
Practice Address - Zip Code:93238-9704
Practice Address - Country:US
Practice Address - Phone:760-376-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI08910617101YA0400X, 172V00000X, 373H00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker