Healthcare Provider Details

I. General information

NPI: 1003118555
Provider Name (Legal Business Name): ALVARO JOSE ALTAMIRANO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15225 NW 77TH AVE
MIAMI LAKES FL
33014-7804
US

IV. Provider business mailing address

4353 NW 77TH AVE FL 3
MIAMI FL
33166-6736
US

V. Phone/Fax

Practice location:
  • Phone: 305-230-4821
  • Fax: 888-498-3163
Mailing address:
  • Phone: 305-204-0333
  • Fax: 305-359-7546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME109107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: