Healthcare Provider Details

I. General information

NPI: 1992154975
Provider Name (Legal Business Name): ALTERRA MED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11741 VALLEY VIEW ST STE A
CYPRESS CA
90630-5500
US

IV. Provider business mailing address

11741 VALLEY VIEW ST STE A
CYPRESS CA
90630-5500
US

V. Phone/Fax

Practice location:
  • Phone: 714-897-1071
  • Fax: 714-373-4696
Mailing address:
  • Phone: 714-897-1071
  • Fax: 714-373-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE BALKCOM
Title or Position: ADMINISTRATOR
Credential:
Phone: 951-847-5883