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NPI Code Detail

MEDICARE: GISSELLA MIA ALTAMIRANO

MEDICARE: GISSELLA MIA ALTAMIRANO
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1962126318
Entity Type Code : Individual
Provider Name (Legal Business Name) : GISSELLA MIA ALTAMIRANO
Provider Business Mailing Address
First Line : 14819 SHERMAN WAY UNIT 9
Second Line :
City : VAN NUYS
State : CA
Zip : 91405-2263
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3210 W BURBANK BLVD STE B
Second Line :
City : BURBANK
State : CA
Zip : 91505-2200
Country : US
Telephone Number : 818-638-9586
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2022
Last Update Date : 05/24/2024

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Directions to “ GISSELLA MIA ALTAMIRANO ” Practice Location

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