MEDICARE: MRS. ROHZAN GRACE ALTRE PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95009293	CA

General Provider Information

NPI Number	:	1093005225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROHZAN GRACE ALTRE PMHNP-BC

Provider Business Mailing Address
First Line	:	14256 ASTORIA ST
Second Line	:
City	:	SYLMAR
State	:	CA
Zip	:	91342-4121
Country	:	US
Telephone Number	:	707-853-0143
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 CANOGA AVE STE 210
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-7794
Country	:	US
Telephone Number	:	818-805-4296
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2011
Last Update Date	:	02/15/2025

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