Healthcare Provider Details

I. General information

NPI: 1417194259
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 S CENTRAL AVE
LOS ANGELES CA
90011-5527
US

IV. Provider business mailing address

2707 S CENTRAL AVE
LOS ANGELES CA
90011-5527
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE ESPARZA
Title or Position: CFO
Credential:
Phone: 323-725-8751