Healthcare Provider Details

I. General information

NPI: 1083590129
Provider Name (Legal Business Name): JESUS ANTONIO BELTRAN FROYLAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 RAFAEL RIVERA WAY UNIT 1447
LAS VEGAS NV
89113-5372
US

IV. Provider business mailing address

7960 RAFAEL RIVERA WAY UNIT 1447
LAS VEGAS NV
89113-5372
US

V. Phone/Fax

Practice location:
  • Phone: 702-788-3187
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number891257
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number891257
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number891257
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number891257
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: