Provider Demographics
NPI:1770897357
Name:BELTAGUI, AMR (MD)
Entity type:Individual
Prefix:DR
First Name:AMR
Middle Name:
Last Name:BELTAGUI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:AMR ALI
Other - Middle Name:AHMAD
Other - Last Name:BELTAGUI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:21700 COPLEY DR STE 180
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4434
Mailing Address - Country:US
Mailing Address - Phone:909-345-6000
Mailing Address - Fax:
Practice Address - Street 1:21700 COPLEY DR STE 180
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4434
Practice Address - Country:US
Practice Address - Phone:909-345-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1458592084P0800X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA145859OtherCOMMERCIAL INSURERS