{
"Npi": {
"NPI": "1992525497",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ALTAMED HEALTH SERVICES CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2040 CAMFIELD AVENUE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90040-1501",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-499-9303",
"MailingAddressFaxNumber": "323-888-0220",
"FirstLinePracticeLocationAddress": "933 S GLENDORA AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WEST COVINA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91790-4205",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "626-214-3850",
"PracticeLocationAddressFaxNumber": "626-486-9693",
"EnumerationDate": "10/10/2024",
"LastUpdateDate": "10/10/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "YOUNG",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "U",
"AuthorizedOfficialTitle": "VP, PATIENT FINANCIAL SERVICES",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "323-622-2429",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251T00000X",
"TaxonomyName": "PACE Provider Organization",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}