Provider Demographics
NPI:1619271517
Name:ALTAMIRANO, LEON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:ALTAMIRANO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 502045
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-2045
Mailing Address - Country:US
Mailing Address - Phone:619-890-3262
Mailing Address - Fax:858-668-3262
Practice Address - Street 1:150 VALPREDA RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2973
Practice Address - Country:US
Practice Address - Phone:619-890-3262
Practice Address - Fax:858-668-3262
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23734103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46-1010163OtherAB CONSULTING SERVICES