MEDICARE: ALTAMED HEALTH SERVICES CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)		CA
2	261QA0600X	Adult Day Care Clinic/Center	ADUF0427F	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174719181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTAMED HEALTH SERVICES CORP

Provider Business Mailing Address
First Line	:	2040 CAMFIELD AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90040-1501
Country	:	US
Telephone Number	:	323-725-8751
Fax Number	:	323-889-8750

Provider Business Practice Location Address
First Line	:	6210 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022
Country	:	US
Telephone Number	:	323-888-2887
Fax Number	:	323-888-2889

Authorized Official
Title or Position	:	AVP, PATIENT FINANCIAL SERVICES
Name	:	ROBERT U. YOUNG
Credential	:	M.D.
Telephone Number	:	323-622-2429

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	08/31/2011

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Directions to “ALTAMED HEALTH SERVICES CORP ” Practice Location

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