Provider Demographics
NPI:1154016830
Name:ALTAMIRANO, JAYLEEN NADINE
Entity type:Individual
Prefix:
First Name:JAYLEEN
Middle Name:NADINE
Last Name:ALTAMIRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 PINERY VILLA PL
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3273
Mailing Address - Country:US
Mailing Address - Phone:303-596-1651
Mailing Address - Fax:
Practice Address - Street 1:12503 E EUCLID DR STE 55
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-6466
Practice Address - Country:US
Practice Address - Phone:888-754-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician