Provider Demographics
NPI:1437131588
Name:ALTAMIRANO, FRED ANTHONY (CO)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:ANTHONY
Last Name:ALTAMIRANO
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8011 N PADOVA PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-1231
Mailing Address - Country:US
Mailing Address - Phone:520-250-3599
Mailing Address - Fax:520-881-2315
Practice Address - Street 1:5375 E ERICKSON DR
Practice Address - Street 2:#104
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2838
Practice Address - Country:US
Practice Address - Phone:520-881-2312
Practice Address - Fax:520-881-2315
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCO004047222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist