Provider Demographics
NPI:1699876862
Name:ALTAMIRANO, ALFREDO (PA - C, MPAS)
Entity type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:
Last Name:ALTAMIRANO
Suffix:
Gender:M
Credentials:PA - C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 N RILLITO CREEK PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1164
Mailing Address - Country:US
Mailing Address - Phone:520-548-1150
Mailing Address - Fax:520-795-3535
Practice Address - Street 1:4275 N RILLITO CREEK PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1164
Practice Address - Country:US
Practice Address - Phone:520-548-1150
Practice Address - Fax:520-795-3535
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2632363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical