1366834400 NPI number — ALTAMED HEALTH SERVICES CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366834400 NPI number — ALTAMED HEALTH SERVICES CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTAMED HEALTH SERVICES CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALTAMED MEDICAL GROUP-SANTA ANA, CENTRAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366834400
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2040 CAMFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90040-1501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-622-2429
Provider Business Mailing Address Fax Number:
323-889-7399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1155 W CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITES 104-107
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92707-3165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-557-4080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
U.
Authorized Official Title or Position:
VP, PATIENT FINANCIAL SERVICES
Authorized Official Telephone Number:
323-622-2429

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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