Provider Demographics
NPI:1699196378
Name:ALTAMED HEALTH SERVICES
Entity Type:Organization
Organization Name:ALTAMED HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH PROMOTER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-352-7307
Mailing Address - Street 1:2401 S HACIENDA BLVD APT 339
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6902
Mailing Address - Country:US
Mailing Address - Phone:714-352-7307
Mailing Address - Fax:714-541-8032
Practice Address - Street 1:2040 CAMFIELD AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90040
Practice Address - Country:US
Practice Address - Phone:714-352-7307
Practice Address - Fax:714-541-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization