Healthcare Provider Details

I. General information

NPI: 1992590301
Provider Name (Legal Business Name): ALTAMED HEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 E AMAR RD
WEST COVINA CA
91792-1618
US

IV. Provider business mailing address

2040 CAMFIELD AVENUE
LOS ANGELES CA
90040-1501
US

V. Phone/Fax

Practice location:
  • Phone: 626-214-7442
  • Fax: 626-214-7443
Mailing address:
  • Phone: 323-622-2429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

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