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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1992135941
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	:	512 S INDIANA ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90063-3911
Country	:	US
Telephone Number	:	323-307-0195
Fax Number	:	323-307-0162

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

Provider Enumeration Date	:	11/12/2013
Last Update Date	:	08/22/2019

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