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)

General Provider Information

NPI Number	:	1366834400
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	:	323-622-2429
Fax Number	:	323-889-7399

Provider Business Practice Location Address
First Line	:	1155 W CENTRAL AVE
Second Line	:	SUITES 104-107
City	:	SANTA ANA
State	:	CA
Zip	:	92707-3165
Country	:	US
Telephone Number	:	714-557-4080
Fax Number	:

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

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	08/16/2019

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Directions to “ALTAMED HEALTH SERVICES CORP ” Practice Location

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