Healthcare Provider Details

I. General information

NPI: 1346450103
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 ZONAL AVE.
LOS ANGELES CA
90033-1065
US

IV. Provider business mailing address

2040 CAMFIELD AVE
LOS ANGELES CA
90040-1501
US

V. Phone/Fax

Practice location:
  • Phone: 323-223-6146
  • Fax: 323-223-6399
Mailing address:
  • Phone: 323-725-8751
  • Fax: 323-889-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberFHC70591F
License Number StateCA

VIII. Authorized Official

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