Provider Demographics
NPI:1306047410
Name:JOSEPH R ALTAMIRANO MD INC
Entity type:Organization
Organization Name:JOSEPH R ALTAMIRANO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALTAMIRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-463-4411
Mailing Address - Street 1:5300 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1131
Mailing Address - Country:US
Mailing Address - Phone:323-463-4411
Mailing Address - Fax:323-463-4416
Practice Address - Street 1:5300 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1131
Practice Address - Country:US
Practice Address - Phone:323-463-4411
Practice Address - Fax:323-469-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF11156Medicare UPIN
CAW18251Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER