Provider Demographics
NPI:1922871490
Name:ALTAMIRANO, DANTE (AMFT)
Entity Type:Individual
Prefix:MR
First Name:DANTE
Middle Name:
Last Name:ALTAMIRANO
Suffix:
Gender:M
Credentials:AMFT
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 113
Mailing Address - Street 2:
Mailing Address - City:MONTE RIO
Mailing Address - State:CA
Mailing Address - Zip Code:95462-0113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19375 CA-116
Practice Address - Street 2:
Practice Address - City:MONTE RIO
Practice Address - State:CA
Practice Address - Zip Code:95462
Practice Address - Country:US
Practice Address - Phone:707-835-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT144301106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist