Provider Demographics
NPI:1093005225
Name:ALTRE, ROHZAN GRACE (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ROHZAN
Middle Name:GRACE
Last Name:ALTRE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:ROHZAN
Other - Middle Name:GRACE
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:14256 ASTORIA ST
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4121
Mailing Address - Country:US
Mailing Address - Phone:707-853-0143
Mailing Address - Fax:
Practice Address - Street 1:22048 SHERMAN WAY STE 115
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1893
Practice Address - Country:US
Practice Address - Phone:707-853-0143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009293363LP0808X
CA785949163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health