Healthcare Provider Details

I. General information

NPI: 1467971499
Provider Name (Legal Business Name): ALTA FAMILIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9340 CARMEL MOUNTAIN RD STE E
SAN DIEGO CA
92129
US

IV. Provider business mailing address

1155 CAMINO DEL MAR
DEL MAR CA
92014-2605
US

V. Phone/Fax

Practice location:
  • Phone: 858-345-2025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number91733
License Number StateCA

VIII. Authorized Official

Name: DR. CAROL J MCPHETERS
Title or Position: PRESIDENT
Credential: PH.D., BCBA
Phone: 858-345-2025