Healthcare Provider Details

I. General information

NPI: 1386065357
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES CORPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 POMONA BLVD
LOS ANGELES CA
90022-1716
US

IV. Provider business mailing address

5425 POMONA BLVD
LOS ANGELES CA
90022-1716
US

V. Phone/Fax

Practice location:
  • Phone: 323-832-7527
  • Fax: 323-832-7599
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberPT19057
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT YOUNG
Title or Position: AVP PATIENT FINANCIAL SERVICES
Credential: MD
Phone: 323-622-2429