Provider Demographics
NPI:1316424898
Name:BELTRAN, MAUCLIA SELENE (LVN)
Entity type:Individual
Prefix:
First Name:MAUCLIA
Middle Name:SELENE
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-3638
Mailing Address - Country:US
Mailing Address - Phone:956-412-3337
Mailing Address - Fax:
Practice Address - Street 1:1004 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-3638
Practice Address - Country:US
Practice Address - Phone:956-463-2984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330165164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1790847531Medicaid