Provider Demographics
NPI:1760651814
Name:ALTAMED HEALTH SERVICES CORP
Entity Type:Organization
Organization Name:ALTAMED HEALTH SERVICES CORP
Other - Org Name:ALTAMED MEDICAL GROUP-SANTA ANA, BRISTOL
Other - Org Type:Other Name
Authorized Official - Title/Position:VP, PATIENT FINANCIAL SERVICES
Authorized Official - Prefix:
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:323-622-2429
Mailing Address - Fax:323-889-7843
Practice Address - Street 1:2720 S BRISTOL ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6207
Practice Address - Country:US
Practice Address - Phone:714-557-4080
Practice Address - Fax:714-557-2251
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTAMED HEALTH SERVICES CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-22
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551030Medicare Oscar/Certification