Healthcare Provider Details

I. General information

NPI: 1205041746
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RUGBY AVE SUITE 200
HUNTINGTON PARK CA
90255-4066
US

IV. Provider business mailing address

2040 CAMFIELD AVE
LOS ANGELES CA
90040-1501
US

V. Phone/Fax

Practice location:
  • Phone: 323-277-7678
  • Fax: 323-277-7686
Mailing address:
  • Phone: 323-725-8751
  • Fax: 323-889-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000620
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number060000620
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAUDF0117F
License Number StateCA

VIII. Authorized Official

Name: ROBERT U. YOUNG
Title or Position: AVP, PATIENT FINANCIAL SERVICES
Credential: M.D.
Phone: 323-622-2429