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General NPI Number Information
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NPI Number | 1235492885
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Entity Type | Organization
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Legal Business Name | ALTAMED HEALTH SERVICES
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Dates
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Enumeration Date | 06/19/2012
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Last Update Date | 06/19/2012
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Provider Practice Location Address
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Address Line | 2401 S. HACIENDA BLVD. #339
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745
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Country | US
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Telephone | 626-863-3262
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 S HACIENDA BLVD APT 339
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745-6902
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Country | US
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Telephone | 626-863-3262
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Fax |
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Authorized Official
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Title or Position | PROMOTORA
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Name | MARIA JEANNETTE DIAZ
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Credential |
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Telephone | 714-500-0304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 550001008
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License Number State | CA
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