Provider Demographics
NPI:1669159562
Name:ALTAMIRANO-WHITTAKER, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ALTAMIRANO-WHITTAKER
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 1:838 WAHL ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3723
Mailing Address - Country:US
Mailing Address - Phone:951-531-7951
Mailing Address - Fax:
Practice Address - Street 1:838 WAHL ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3723
Practice Address - Country:US
Practice Address - Phone:951-531-7951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49643374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula