Provider Demographics
NPI:1578157277
Name:ALTAMIRANO OSORIO, LUISA MARISOL
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:MARISOL
Last Name:ALTAMIRANO OSORIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W MYERS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-2929
Mailing Address - Country:US
Mailing Address - Phone:559-899-5218
Mailing Address - Fax:
Practice Address - Street 1:3433 W SHAW AVE # 107
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3229
Practice Address - Country:US
Practice Address - Phone:559-476-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor