Provider Demographics
NPI:1972668671
Name:ALTAMIRANO, MARIA E (FOSTER PARENT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:E
Last Name:ALTAMIRANO
Suffix:
Gender:F
Credentials:FOSTER PARENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W 22ND PL
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6561
Mailing Address - Country:US
Mailing Address - Phone:928-373-0329
Mailing Address - Fax:
Practice Address - Street 1:225 W 22ND PL
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6561
Practice Address - Country:US
Practice Address - Phone:928-373-0329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11029385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child