Provider Demographics
NPI:1619177649
Name:ALTAMIRANO, SILVANO (PA)
Entity Type:Individual
Prefix:MR
First Name:SILVANO
Middle Name:
Last Name:ALTAMIRANO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 SW 144TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6853
Mailing Address - Country:US
Mailing Address - Phone:786-553-9617
Mailing Address - Fax:
Practice Address - Street 1:4535 SW 144TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6853
Practice Address - Country:US
Practice Address - Phone:786-553-9617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9100033363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical