Healthcare Provider Details

I. General information

NPI: 1043570989
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 CAMFIELD AVE
COMMERCE CA
90040-1502
US

IV. Provider business mailing address

2040 CAMFIELD AVE
COMMERCE CA
90040-1502
US

V. Phone/Fax

Practice location:
  • Phone: 323-558-7637
  • Fax:
Mailing address:
  • Phone: 323-558-7637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CASTULO DE LA ROCHA
Title or Position: CEO
Credential:
Phone: 877-462-2582