Healthcare Provider Details

I. General information

NPI: 1578651469
Provider Name (Legal Business Name): MS. MARIA E ALTAMIRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA E ALTAMIRANO PSCHYCHATRIC TECH LL

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 E WINGATE ST
COVINA CA
91724-2503
US

IV. Provider business mailing address

1147 E WINGATE ST
COVINA CA
91724-2503
US

V. Phone/Fax

Practice location:
  • Phone: 562-467-0209
  • Fax:
Mailing address:
  • Phone: 562-467-0209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number27554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: