MEDICARE: ALTAMED HEALTH SERVICES

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	302R00000X	Health Maintenance Organization		CA

General Provider Information

NPI Number	:	1699196378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTAMED HEALTH SERVICES

Provider Business Mailing Address
First Line	:	2401 S HACIENDA BLVD APT 339
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-6902
Country	:	US
Telephone Number	:	714-352-7307
Fax Number	:	714-541-8032

Provider Business Practice Location Address
First Line	:	2040 CAMFIELD AVE.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90040
Country	:	US
Telephone Number	:	714-352-7307
Fax Number	:	714-541-8032

Authorized Official
Title or Position	:	HEALTH PROMOTER
Name	:	MARIA DIAZ
Credential	:
Telephone Number	:	714-352-7307

Provider Enumeration Date	:	12/23/2013
Last Update Date	:	12/23/2013

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Directions to “ALTAMED HEALTH SERVICES ” Practice Location

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