Basic Information
| Provider Information | |||||||||
| NPI: | 1508110297 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALTAMED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 IMA LOAT CT. | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7605541711 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1814 W LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928016730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884999303 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2012 | ||||||||
| LastUpdateDate: | 11/01/2012 | ||||||||
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| AuthorizedOfficialLastName: | SKREDE | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
| AuthorizedOfficialMiddleName: | JESUS | ||||||||
| AuthorizedOfficialTitleorPosition: | PROMOTORA I | ||||||||
| AuthorizedOfficialTelephone: | 8884999303 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174H00000X | 174H00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Health Educator |
No ID Information.