Healthcare Provider Details

I. General information

NPI: 1952205015
Provider Name (Legal Business Name): JUAN MANUEL ALTAMIRANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6411 FANNIN ST
HOUSTON TX
77030-1501
US

IV. Provider business mailing address

701 RICHMOND AVE UNIT 1, APT 854
HOUSTON TX
77006
US

V. Phone/Fax

Practice location:
  • Phone: 713-704-4000
  • Fax:
Mailing address:
  • Phone: 346-541-4079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: