Provider Demographics
NPI:1851539977
Name:ALTAVAS, MYRNA RAMOS (DDS)
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:RAMOS
Last Name:ALTAVAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10304 SKILES DRIVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311
Mailing Address - Country:US
Mailing Address - Phone:661-343-5018
Mailing Address - Fax:
Practice Address - Street 1:4100 EMPIRE DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-246-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA575481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57548OtherCALIFORNIA DENTAL LICENSE