Healthcare Provider Details

I. General information

NPI: 1720617715
Provider Name (Legal Business Name): AMADO JONATHAN BELTRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 S ATLANTIC BLVD
EAST LOS ANGELES CA
90022-3211
US

IV. Provider business mailing address

607 S ATLANTIC BLVD
EAST LOS ANGELES CA
90022-3211
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-9191
  • Fax:
Mailing address:
  • Phone: 323-268-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA187104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: