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General NPI Number Information
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NPI Number | 1508110297
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Entity Type | Organization
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Legal Business Name | ALTAMED
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Dates
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Enumeration Date | 11/01/2012
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 1814 W LINCOLN AVE
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City | ANAHEIM
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State | CA
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Zip | 92801-6730
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Country | US
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Telephone | 888-499-9303
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Fax |
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Provider Business Mailing Address
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Address Line | 25 IMA LOAT CT.
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City | NEWPORT BEACH
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State | CA
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Zip | 92663
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Country | US
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Telephone | 760-554-1711
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Fax |
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Authorized Official
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Title or Position | PROMOTORA I
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Name | MARIA JESUS SKREDE
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Credential |
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Telephone | 888-499-9303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 174H00000X
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License Number State |
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