Healthcare Provider Details

I. General information

NPI: 1013746163
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W SUNFLOWER AVE ROOMS 243-244, 252 & 254
SANTA ANA CA
92704-7916
US

IV. Provider business mailing address

2040 CAMFIELD AVENUE
LOS ANGELES CA
90040-1501
US

V. Phone/Fax

Practice location:
  • Phone: 714-274-0373
  • Fax: 323-597-2113
Mailing address:
  • Phone: 888-499-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

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