Healthcare Provider Details

I. General information

NPI: 1104252378
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 CRUSADO LN
LOS ANGELES CA
90033-1512
US

IV. Provider business mailing address

2040 CAMFIELD AVE
LOS ANGELES CA
90040-1501
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-0623
  • Fax: 323-889-7399
Mailing address:
  • Phone: 323-622-2429
  • Fax: 323-889-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

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