Basic Information
| Provider Information | |||||||||
| NPI: | 1578157277 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALTAMIRANO OSORIO | ||||||||
| FirstName: | LUISA | ||||||||
| MiddleName: | MARISOL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 402 W MYERS AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937062929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5598995218 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3433 W SHAW AVE # 107 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937113229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594762115 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2021 | ||||||||
| LastUpdateDate: | 02/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.