Healthcare Provider Details

I. General information

NPI: 1982990859
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 MARTIN LUTHER KING JR BLVD
LYNWOOD CA
90262-3625
US

IV. Provider business mailing address

2040 CAMFIELD AVE
LOS ANGELES CA
90040-1501
US

V. Phone/Fax

Practice location:
  • Phone: 310-632-0415
  • Fax: 310-639-2734
Mailing address:
  • Phone: 323-725-8751
  • Fax: 323-889-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

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