Basic Information
| Provider Information | |||||||||
| NPI: | 1386833960 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALMA FAMILY SERVICES | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ALMA FAMILY SERVICES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 900 CORPORATE CENTER DR | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | MONTEREY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917547600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235264016 | ||||||||
| FaxNumber: | 3235264096 | ||||||||
| Practice Location | |||||||||
| Address1: | 6505 ROSEMEAD BLVD. | ||||||||
| Address2: | STE 101, 102, 105, 105A | ||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906603542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626921517 | ||||||||
| FaxNumber: | 5626991378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2007 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CARACOZA | ||||||||
| AuthorizedOfficialFirstName: | MARIA DE LOURDES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3235264016 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 7709 | 01 | CA | MEDI-CAL PROVIDER NUMBER | OTHER |