Provider Demographics
NPI:1578651469
Name:ALTAMIRANO, MARIA E
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:E
Last Name:ALTAMIRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:E
Other - Last Name:ALTAMIRANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSCHYCHATRIC TECH LL
Mailing Address - Street 1:1147 E WINGATE ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2503
Mailing Address - Country:US
Mailing Address - Phone:562-467-0209
Mailing Address - Fax:
Practice Address - Street 1:1147 E WINGATE ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2503
Practice Address - Country:US
Practice Address - Phone:562-467-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27554167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician