Provider Demographics
NPI:1578759114
Name:HUGO G. ALTAMIRANO MD LLC
Entity Type:Organization
Organization Name:HUGO G. ALTAMIRANO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGO
Authorized Official - Middle Name:G
Authorized Official - Last Name:ALTAMIRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-375-9292
Mailing Address - Street 1:745 N 500 W # 200
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1472
Mailing Address - Country:US
Mailing Address - Phone:801-375-9292
Mailing Address - Fax:801-375-9290
Practice Address - Street 1:745 N 500 W # 200
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1472
Practice Address - Country:US
Practice Address - Phone:801-375-9292
Practice Address - Fax:801-375-9290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055987Medicare PIN