Healthcare Provider Details

I. General information

NPI: 1003511387
Provider Name (Legal Business Name): ALISSON DANIELA ITURBURU ALTAMIRANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 HANSHAW RD
ITHACA NY
14850-1549
US

IV. Provider business mailing address

905 HANSHAW RD
ITHACA NY
14850-1549
US

V. Phone/Fax

Practice location:
  • Phone: 607-277-2170
  • Fax:
Mailing address:
  • Phone: 607-277-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number346900
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: