MEDICARE: JACKELINE CELESTE BELTRAN

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1316798358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKELINE CELESTE BELTRAN

Provider Business Mailing Address
First Line	:	1728 ORO VISTA RD UNIT 166
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-6513
Country	:	US
Telephone Number	:	619-564-0169
Fax Number	:

Provider Business Practice Location Address
First Line	:	1728 ORO VISTA RD UNIT 166
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-6513
Country	:	US
Telephone Number	:	619-564-0169
Fax Number	:

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

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	03/28/2024

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