Provider Demographics
NPI:1730292350
Name:ALTESMAN, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:ALTESMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 BISHOP ST
Mailing Address - Street 2:SUITE A-150
Mailing Address - City:SAN LUIS ODISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4693
Mailing Address - Country:US
Mailing Address - Phone:805-541-6000
Mailing Address - Fax:805-541-6001
Practice Address - Street 1:1551 BISHOP ST
Practice Address - Street 2:SUITE A-150
Practice Address - City:SAN LUIS ODISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4693
Practice Address - Country:US
Practice Address - Phone:805-541-6000
Practice Address - Fax:805-541-6001
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA159744-12084P0800X
NY159774-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02223843Medicaid
NY51J711Medicare ID - Type Unspecified
NY835802Medicare UPIN