Healthcare Provider Details

I. General information

NPI: 1588936330
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 W 17TH ST
SANTA ANA CA
92706-3455
US

IV. Provider business mailing address

1227 W. 17TH STREET
SANTA ANA CA
92706
US

V. Phone/Fax

Practice location:
  • Phone: 714-500-0351
  • Fax:
Mailing address:
  • Phone: 714-500-0351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State

VIII. Authorized Official

Name: CASTULO DE LA ROCHA
Title or Position: CEO
Credential:
Phone: 323-725-8751