Healthcare Provider Details

I. General information

NPI: 1760091201
Provider Name (Legal Business Name): AMARA MICHELLA ALTMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 S BASCOM AVE STE 100
CAMPBELL CA
95008-5541
US

IV. Provider business mailing address

1620 SANTA CLARA DR STE 100
ROSEVILLE CA
95661-3559
US

V. Phone/Fax

Practice location:
  • Phone: 800-913-2615
  • Fax:
Mailing address:
  • Phone: 916-786-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95018342
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number844770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: