Healthcare Provider Details

I. General information

NPI: 1841109709
Provider Name (Legal Business Name): MARISABEL BELTRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 AVE LAUREL # 2A
BAYAMON PR
00956-3273
US

IV. Provider business mailing address

PO BOX 2117
UTUADO PR
00641-2117
US

V. Phone/Fax

Practice location:
  • Phone: 787-400-6000
  • Fax:
Mailing address:
  • Phone: 787-316-7064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-2833880
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: