Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME109107 | FL |
NPI | 1003118555 |
---|---|
Provider Name | Alvaro Jose Altamirano |
First Address | Orlando, FL 32801-3221 |
Second Address | Kissimmee, FL 34743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2010 |
Last Update Date | 07/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003306400 | (05) | FL |
EU080Z | (05) | FL |