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General NPI Number Information
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NPI Number | 1205049111
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Entity Type | Individual
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Provider Name | BRENDA RACHEL ALTOSE M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 5010 MAYFIELD RD STE 306
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City | CLEVELAND
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State | OH
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Zip | 44124-2697
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Country | US
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Telephone | 216-591-9161
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Fax | 216-455-8065
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Provider Business Mailing Address
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Address Line | 2408 MILTON RD
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City | CLEVELAND
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State | OH
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Zip | 44118-4635
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Country | US
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Telephone | 216-245-2439
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Fax | 216-455-8065
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 57.010963
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License Number State | OH
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