Healthcare Provider Details

I. General information

NPI: 1629283197
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

2040 CAMFIELD AVE
LOS ANGELES CA
90040-1501
US

V. Phone/Fax

Practice location:
  • Phone: 323-669-2113
  • Fax: 323-906-8003
Mailing address:
  • Phone: 323-889-7349
  • Fax: 323-889-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberFHC71094F
License Number StateCA

VIII. Authorized Official

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