Provider Demographics
NPI:1215316039
Name:JACQUELINE BELTRAN DO PA
Entity type:Organization
Organization Name:JACQUELINE BELTRAN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:713-291-1179
Mailing Address - Street 1:3355 BLACKBURN ST
Mailing Address - Street 2:APT 5402
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1588
Mailing Address - Country:US
Mailing Address - Phone:713-291-1179
Mailing Address - Fax:
Practice Address - Street 1:8615 LULLWATER DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-4754
Practice Address - Country:US
Practice Address - Phone:214-221-0444
Practice Address - Fax:214-343-5205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1963208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty