Healthcare Provider Details

I. General information

NPI: 1003095464
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CITADEL DR STE 490
LOS ANGELES CA
90040
US

IV. Provider business mailing address

500 CITADEL DR STE 490
LOS ANGELES CA
90040
US

V. Phone/Fax

Practice location:
  • Phone: 323-725-8751
  • Fax: 323-889-7399
Mailing address:
  • Phone: 323-725-8751
  • Fax: 323-889-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberEAP11568F
License Number StateCA

VIII. Authorized Official

Name: MR. JOSE ESPARZA
Title or Position: VP OF FINANCE AND CFO
Credential:
Phone: 323-725-8751