Basic Information
| Provider Information | |||||||||
| NPI: | 1386020303 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALTAMED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2040 CAMFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900401502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237258751 | ||||||||
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| Practice Location | |||||||||
| Address1: | 535 S 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917233013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262141484 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2015 | ||||||||
| LastUpdateDate: | 07/31/2015 | ||||||||
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| AuthorizedOfficialLastName: | DE LA ROCHA | ||||||||
| AuthorizedOfficialFirstName: | CASTULO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8774622582 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | JD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302R00000X | 847492 | CA | Y | Managed Care Organizations | Health Maintenance Organization |
No ID Information.