Basic Information
| Provider Information | |||||||||
| NPI: | 1427675933 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALTUS | ||||||||
| FirstName: | BRYCE | ||||||||
| MiddleName: | ALEXANDER | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4122 W INNOVATIVE DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850863847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6237775943 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3825 E THOUSAND OAKS BLVD STE O | ||||||||
| Address2: | |||||||||
| City: | WESTLAKE VILLAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913626637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054961674 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2020 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | DA12482 | AZ | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.