MEDICARE: JESUS ANTONIO BELTRAN FROYLAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WI0500X	Infusion Therapy Registered Nurse	891257	NV
2	163WM0705X	Medical-Surgical Registered Nurse	891257	NV
3	163WX1500X	Ostomy Care Registered Nurse	891257	NV
4	163WG0000X	General Practice Registered Nurse	891257	NV

General Provider Information

NPI Number	:	1083590129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS ANTONIO BELTRAN FROYLAN

Provider Business Mailing Address
First Line	:	7960 RAFAEL RIVERA WAY UNIT 1447
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-5372
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7960 RAFAEL RIVERA WAY UNIT 1447
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-5372
Country	:	US
Telephone Number	:	702-788-3187
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2025
Last Update Date	:	08/13/2025

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