Provider Demographics
NPI:1235808106
Name:CENTRO MEDICO ALTENO
Entity Type:Organization
Organization Name:CENTRO MEDICO ALTENO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTIAN
Authorized Official - Middle Name:ORLANDO
Authorized Official - Last Name:CORTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-417-1127
Mailing Address - Street 1:1317 EDGEWATER DR STE 4327
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AV. JOSE GONZALEZ CARNICERITO 1025
Practice Address - Street 2:JARDINES DE TEPA
Practice Address - City:TEPATITLAN DE MORELOS
Practice Address - State:JALISCO
Practice Address - Zip Code:47680
Practice Address - Country:MX
Practice Address - Phone:378-781-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MONR960707KP0OtherSTATE