Provider Demographics
NPI:1811203060
Name:ALTAF, ANGELINA MARIE
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:MARIE
Last Name:ALTAF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 RHIANNON CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-4302
Mailing Address - Country:US
Mailing Address - Phone:702-778-3527
Mailing Address - Fax:702-778-3016
Practice Address - Street 1:315 RHIANNON CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-4302
Practice Address - Country:US
Practice Address - Phone:702-778-3527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NVCI0051101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst