Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 S EL CAMINO REAL SUITE #104
OCEANSIDE CA
92054-6260
US

IV. Provider business mailing address

2125 S EL CAMINO REAL SUITE #104
OCEANSIDE CA
92054-6260
US

V. Phone/Fax

Practice location:
  • Phone: 760-967-5898
  • Fax: 760-967-6042
Mailing address:
  • Phone: 760-967-5898
  • Fax: 760-967-6042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG36206
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG36206
License Number StateCA

VIII. Authorized Official

Name: DENNIS B. ALTERS
Title or Position: CEO
Credential: MD
Phone: 760-967-5898