Healthcare Provider Details

I. General information

NPI: 1124841887
Provider Name (Legal Business Name): CHRISTINA BELTRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 MCNUTT RD
SANTA TERESA NM
88008-9621
US

IV. Provider business mailing address

3244 MISSOURI AVE APT C
LAS CRUCES NM
88011-4885
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-6101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSAH-2024-0196
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: