=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124498308
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JESSICA A ALTAMIRANO MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2015
-----------------------------------------------------
Last Update Date | 10/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13936 NW 7TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33168-2908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-600-2791
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 N BAYSHORE DR # 1412
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33132-3251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-600-2791
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JESSICA A ALTAMIRANO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 786-600-2791
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | ME113540
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------