Provider Demographics
NPI:1245231174
Name:ALTAVAS, VALERIE CYNTHIA (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:CYNTHIA
Last Name:ALTAVAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 HOTEL CIR N
Mailing Address - Street 2:APT 371
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2906
Mailing Address - Country:US
Mailing Address - Phone:619-501-9110
Mailing Address - Fax:619-472-4530
Practice Address - Street 1:655 EUCLID AVE
Practice Address - Street 2:SUITE 302 304
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2957
Practice Address - Country:US
Practice Address - Phone:619-472-4575
Practice Address - Fax:619-472-4530
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01656931Medicaid
NYMDB334OtherPREFERRED CARE
NYMDB334OtherPREFERRED CARE
NY16025VMedicare ID - Type Unspecified