Healthcare Provider Details

I. General information

NPI: 1912185679
Provider Name (Legal Business Name): SEBASTIAN A ALTAMIRANO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 W OLYMPIC BLVD SUITE M103
LOS ANGELES CA
90015-3809
US

IV. Provider business mailing address

PO BOX 546
CARDIFF CA
92007-0546
US

V. Phone/Fax

Practice location:
  • Phone: 323-375-5147
  • Fax: 323-375-5155
Mailing address:
  • Phone: 858-436-7600
  • Fax: 760-797-1845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: