Healthcare Provider Details

I. General information

NPI: 1821992058
Provider Name (Legal Business Name): JOSHUA EZRA ALTAMIRANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16365 NW TWIN OAKS DR #200
BEAVERTON OR
97006
US

IV. Provider business mailing address

16055 SW WALKER RD # 2443
BEAVERTON OR
97006-4942
US

V. Phone/Fax

Practice location:
  • Phone: 503-828-3402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: