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General NPI Number Information
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NPI Number | 1003164724
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Entity Type | Organization
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Legal Business Name | ALTAMED HEALTH SERVICES CORPORATION
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 5425 POMONA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-1716
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Country | US
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Telephone | 323-832-7527
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Fax | 323-832-7599
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Provider Business Mailing Address
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Address Line | 5425 POMONA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022
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Country | US
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Telephone | 323-832-7527
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Fax | 323-832-7599
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Authorized Official
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Title or Position | AVP PATIENT FINANCIAL SERVICES
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Name | DR. ROBERT YOUNG
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Credential | M.D.
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Telephone | 323-622-2429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | PT 19057
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License Number State | CA
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