Provider Demographics
NPI:1497532360
Name:ALTAMED HEALTH SERVICES CORP
Entity Type:Organization
Organization Name:ALTAMED HEALTH SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, PFS
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:UY
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
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:323-622-2429
Mailing Address - Fax:
Practice Address - Street 1:513 E LIME AVE STE 102
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2983
Practice Address - Country:US
Practice Address - Phone:626-788-0290
Practice Address - Fax:323-853-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)