Provider Demographics
NPI:1558855734
Name:RIVERA BELTRAN, HERIBERTO (APRN)
Entity type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:RIVERA BELTRAN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 INFINITY LN
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-3204
Mailing Address - Country:US
Mailing Address - Phone:619-537-9005
Mailing Address - Fax:
Practice Address - Street 1:5757 PLAZA DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5000
Practice Address - Country:US
Practice Address - Phone:619-537-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV832670363LP2300X
NM57111363LP2300X
CA95011671363LP2300X
FLARNP9244033363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care