Provider Demographics
NPI:1194447037
Name:BELTRAN, LETICIA MINA
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:MINA
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W ATEN RD
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-9423
Mailing Address - Country:US
Mailing Address - Phone:760-592-0088
Mailing Address - Fax:
Practice Address - Street 1:502 W ATEN RD STE 105
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251-9423
Practice Address - Country:US
Practice Address - Phone:760-592-0088
Practice Address - Fax:760-370-9236
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician