Provider Demographics
NPI:1053449470
Name:ALTENBERN, CHARLES P (CCP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:P
Last Name:ALTENBERN
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10930 N TATUM BLVD
Mailing Address - Street 2:#103
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6069
Mailing Address - Country:US
Mailing Address - Phone:602-263-7600
Mailing Address - Fax:602-212-0365
Practice Address - Street 1:10930 N TATUM BLVD
Practice Address - Street 2:#103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6069
Practice Address - Country:US
Practice Address - Phone:602-263-7600
Practice Address - Fax:602-212-0365
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist