MEDICARE: DENNIS B. ALTERS, MD, A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	G36206	CA
2	2084P0800X	Psychiatry Physician	G36206	CA

General Provider Information

NPI Number	:	1134145527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENNIS B. ALTERS, MD, A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2125 S EL CAMINO REAL
Second Line	:	SUITE #104
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6260
Country	:	US
Telephone Number	:	760-967-5898
Fax Number	:	760-967-6042

Provider Business Practice Location Address
First Line	:	2125 S EL CAMINO REAL
Second Line	:	SUITE #104
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6260
Country	:	US
Telephone Number	:	760-967-5898
Fax Number	:	760-967-6042

Authorized Official
Title or Position	:	CEO
Name	:	DENNIS B. ALTERS
Credential	:	MD
Telephone Number	:	760-967-5898

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	02/08/2011

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