Provider Demographics
NPI:1427675933
Name:ALTUS, BRYCE ALEXANDER (AUD)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:ALEXANDER
Last Name:ALTUS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2674 E MAIN ST STE I
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2800
Mailing Address - Country:US
Mailing Address - Phone:805-653-7333
Mailing Address - Fax:
Practice Address - Street 1:2674 E MAIN ST STE I
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2800
Practice Address - Country:US
Practice Address - Phone:805-653-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA12482231H00000X
CAAU3708231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist