Healthcare Provider Details

I. General information

NPI: 1508110297
Provider Name (Legal Business Name): ALTAMED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 W LINCOLN AVE
ANAHEIM CA
92801-6730
US

IV. Provider business mailing address

25 IMA LOAT CT.
NEWPORT BEACH CA
92663
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-9303
  • Fax:
Mailing address:
  • Phone: 760-554-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number174H00000X
License Number State

VIII. Authorized Official

Name: MARIA JESUS SKREDE
Title or Position: PROMOTORA I
Credential:
Phone: 888-499-9303