Provider Demographics
NPI:1104235183
Name:BELTRAN, MELCHOR (NP-C)
Entity type:Individual
Prefix:
First Name:MELCHOR
Middle Name:
Last Name:BELTRAN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5617 BYINGTON DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-3694
Mailing Address - Country:US
Mailing Address - Phone:510-790-9455
Mailing Address - Fax:
Practice Address - Street 1:5617 BYINGTON DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-3694
Practice Address - Country:US
Practice Address - Phone:510-790-9455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily