Healthcare Provider Details

I. General information

NPI: 1699196378
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 CAMFIELD AVE.
LOS ANGELES CA
90040
US

IV. Provider business mailing address

2401 S HACIENDA BLVD APT 339
HACIENDA HEIGHTS CA
91745-6902
US

V. Phone/Fax

Practice location:
  • Phone: 714-352-7307
  • Fax: 714-541-8032
Mailing address:
  • Phone: 714-352-7307
  • Fax: 714-541-8032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateCA

VIII. Authorized Official

Name: MARIA DIAZ
Title or Position: HEALTH PROMOTER
Credential:
Phone: 714-352-7307