Healthcare Provider Details

I. General information

NPI: 1306051032
Provider Name (Legal Business Name): ALTAMEDIX CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 N FREEWAY BLVD SUITE 500
SACRAMENTO CA
95834-1237
US

IV. Provider business mailing address

4234 N FREEWAY BLVD SUITE 500
SACRAMENTO CA
95834-1237
US

V. Phone/Fax

Practice location:
  • Phone: 916-648-3999
  • Fax: 916-648-1919
Mailing address:
  • Phone: 916-648-3999
  • Fax: 916-648-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. MIRON BALYASNY
Title or Position: ADMINISTRATOR
Credential:
Phone: 916-648-3999