Provider Demographics
NPI:1346800943
Name:ALTAMIRANO, SAVANNAH M (MED)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:M
Last Name:ALTAMIRANO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11331 IMPRESSIVE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6376
Mailing Address - Country:US
Mailing Address - Phone:361-759-0227
Mailing Address - Fax:
Practice Address - Street 1:20770 US HIGHWAY 281 N STE 108-173
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7655
Practice Address - Country:US
Practice Address - Phone:844-568-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-19-36921103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst