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General NPI Number Information
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NPI Number | 1578928099
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Entity Type | Organization
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Legal Business Name | ALAMO DIVERSE MEDICAL SERVICES PLLC
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 8508 SIR LANCELOT
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City | SAN ANTONIO
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State | TX
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Zip | 78240-4920
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Country | US
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Telephone | 210-346-8188
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Fax |
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Provider Business Mailing Address
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Address Line | 8508 SIR LANCELOT
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City | SAN ANTONIO
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State | TX
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Zip | 78240-4920
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Country | US
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Telephone | 210-346-8188
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/MANAGER
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Name | RAY ALTAMIRANO
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Credential | MD
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Telephone | 210-912-1969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | P0535
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License Number State | TX
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