Provider Demographics
NPI:1497546543
Name:ALTAMIRANO, MARIA ALEJANDRA (IBCLC, BSN, RN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ALEJANDRA
Last Name:ALTAMIRANO
Suffix:
Gender:X
Credentials:IBCLC, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11230 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-2137
Mailing Address - Country:US
Mailing Address - Phone:786-253-8690
Mailing Address - Fax:
Practice Address - Street 1:7684 WILES RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2069
Practice Address - Country:US
Practice Address - Phone:954-715-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9358459163WL0100X
FLL-165867163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant