Healthcare Provider Details

I. General information

NPI: 1881495380
Provider Name (Legal Business Name): ARMANDO ALTAMIRANO PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 SECOND ST SUITE 209
NORCO CA
92860
US

IV. Provider business mailing address

1640 2ND ST STE 209
NORCO CA
92860-2983
US

V. Phone/Fax

Practice location:
  • Phone: 805-500-6080
  • Fax:
Mailing address:
  • Phone: 805-500-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95033726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: