Provider Demographics
NPI:1467038935
Name:BELTRAN GUTIERREZ, EMMANUEL (MD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:BELTRAN GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 CHAPARRAL DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-6115
Mailing Address - Country:US
Mailing Address - Phone:760-234-2691
Mailing Address - Fax:
Practice Address - Street 1:2024 CHAPARRAL DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-6115
Practice Address - Country:US
Practice Address - Phone:760-234-2691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA194948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine