Basic Information
| Provider Information | |||||||||
| NPI: | 1659773968 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALTAMED HEALTH SERVICE CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2720 S BRISTOL ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927046210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144265222 | ||||||||
| FaxNumber: | 7145572251 | ||||||||
| Practice Location | |||||||||
| Address1: | 2720 S BRISTOL ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927046210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144265222 | ||||||||
| FaxNumber: | 7145572251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2014 | ||||||||
| LastUpdateDate: | 09/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | CORREA | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSISTANT MANGER-OC WOMEN'S HEALTH | ||||||||
| AuthorizedOfficialTelephone: | 7144265117 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Community Health Worker |
No ID Information.