Provider Demographics
NPI:1003118555
Name:ALTAMIRANO, ALVARO JOSE (MD)
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:JOSE
Last Name:ALTAMIRANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:121 S ORANGE AVE
Mailing Address - Street 2:SUITE 940
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3221
Mailing Address - Country:US
Mailing Address - Phone:321-332-6947
Mailing Address - Fax:407-658-9688
Practice Address - Street 1:729 BUENAVENTURA BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743
Practice Address - Country:US
Practice Address - Phone:407-344-9959
Practice Address - Fax:407-344-9971
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME109107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003306400Medicaid
FLEU080ZMedicaid