Healthcare Provider Details

I. General information

NPI: 1700405701
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

972 GOODRICH BLVD RM 100
COMMERCE CA
90022-4114
US

IV. Provider business mailing address

2040 CAMFIELD AVE
LOS ANGELES CA
90040-1501
US

V. Phone/Fax

Practice location:
  • Phone: 323-914-9804
  • Fax: 323-853-6935
Mailing address:
  • Phone: 323-622-2429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT U YOUNG
Title or Position: VP, PATIENT FINANCIAL SERVICES
Credential: MD
Phone: 323-622-2429