Healthcare Provider Details

I. General information

NPI: 1053580175
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 01/04/2019
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

2040 CAMFIELD AVE
LOS ANGELES CA
90040-1501
US

V. Phone/Fax

Practice location:
  • Phone: 714-500-0340
  • Fax: 714-824-8886
Mailing address:
  • Phone: 323-622-2429
  • Fax: 323-889-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
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