Healthcare Provider Details

I. General information

NPI: 1225747611
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W 3RD ST STE 301
LOS ANGELES CA
90057-2285
US

IV. Provider business mailing address

2040 CAMFIELD AVE
COMMERCE CA
90040-1502
US

V. Phone/Fax

Practice location:
  • Phone: 844-434-3114
  • Fax:
Mailing address:
  • Phone: 323-725-8751
  • 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: DR. ROBERT YOUNG
Title or Position: VICE PRESIDENT, PFS
Credential:
Phone: 323-622-2429