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NPI Code Detail

MEDICARE: JACQUELINE BELTRAN DO PA

MEDICARE: JACQUELINE BELTRAN DO PA
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
1208100000XPhysical Medicine & Rehabilitation PhysicianP1963TX

General Provider Information

NPI Number : 1215316039
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACQUELINE BELTRAN DO PA
Provider Business Mailing Address
First Line : 3355 BLACKBURN ST
Second Line : APT 5402
City : DALLAS
State : TX
Zip : 75204-1588
Country : US
Telephone Number : 713-291-1179
Fax Number :
Provider Business Practice Location Address
First Line : 8615 LULLWATER DR
Second Line :
City : DALLAS
State : TX
Zip : 75238-4754
Country : US
Telephone Number : 214-221-0444
Fax Number : 214-343-5205
Authorized Official
Title or Position : PRESIDENT
Name : JACQUELINE BELTRAN
Credential : DO
Telephone Number : 713-291-1179
Provider Enumeration Date : 05/26/2015
Last Update Date : 05/26/2015

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