Provider Demographics
NPI:1295574648
Name:ALTAMED HEALTH SERVICES CORP
Entity type:Organization
Organization Name:ALTAMED HEALTH SERVICES CORP
Other - Org Name:<UNAVAIL>
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 1:3601 W SUNFLOWER AVE
Practice Address - Street 2:ROOMS 200-242, 245-251, 253, & 255-261
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7916
Practice Address - Country:US
Practice Address - Phone:844-434-3114
Practice Address - Fax:714-638-5991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)