Healthcare Provider Details

I. General information

NPI: 1346927985
Provider Name (Legal Business Name): DAISY BELTRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2023
Last Update Date: 07/04/2023
Certification Date: 07/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4939 W FULLERTON AVE
CHICAGO IL
60639-2505
US

IV. Provider business mailing address

4939 W FULLERTON AVE
CHICAGO IL
60639-2505
US

V. Phone/Fax

Practice location:
  • Phone: 312-970-1399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: