Provider Demographics
NPI:1346450103
Name:ALTAMED HEALTH SERVICES CORP
Entity Type:Organization
Organization Name:ALTAMED HEALTH SERVICES CORP
Other - Org Name:ALTAMED/BUENACARE HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP, PATIENT FINANCIAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:U
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-622-2429
Mailing Address - Street 1:2040 CAMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1501
Mailing Address - Country:US
Mailing Address - Phone:323-725-8751
Mailing Address - Fax:323-889-7843
Practice Address - Street 1:1701 ZONAL AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1065
Practice Address - Country:US
Practice Address - Phone:323-223-6146
Practice Address - Fax:323-223-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFHC70591F261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70591FMedicaid
CAFHC70591FMedicaid