Provider Demographics
NPI:1518169721
Name:ALTAMIRANO, JESSICA ALEXANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ALEXANDRA
Last Name:ALTAMIRANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 100 DEPT#394
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:941-300-4440
Mailing Address - Fax:941-404-1760
Practice Address - Street 1:18360 NW 47TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2934
Practice Address - Country:US
Practice Address - Phone:786-800-5631
Practice Address - Fax:888-285-1741
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113540207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024341300Medicaid
FL14P0WOtherBCBS PROVIDER #