Provider Demographics
NPI:1053567768
Name:BELTRAN, LORI M (DO)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:M
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:M
Other - Last Name:LAVINSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1600 OWENS ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2261
Mailing Address - Country:US
Mailing Address - Phone:415-833-2000
Mailing Address - Fax:
Practice Address - Street 1:350 30TH ST
Practice Address - Street 2:SUITE 407
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3424
Practice Address - Country:US
Practice Address - Phone:510-419-0230
Practice Address - Fax:510-419-0273
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A10403OtherMEDICAL LICENSE
CAMMM00345MMedicare PIN