NPIMap

Organization Active NPI

Altamed Health Services Corp

Doing business as AltaMed Medical and Dental Group-East Los Angeles, 1st Street

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1134492937
Registry record updated Aug 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ALTAMED HEALTH SERVICES CORP
Doing business as
AltaMed Medical and Dental Group-East Los Angeles, 1st Street
Practice address
2219 E 1St St
Los Angeles, CA 90033-3901
Phone
(323) 269-0424
Fax
(323) 780-9432
NPI assigned
Feb 10, 2012
Last updated
Aug 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert U. Young, M.D.
Title
VP, Patient Financial Services
Phone
(323) 622-2429

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

2219 E 1St St
Los Angeles, CA 90033-3901

Mailing address

2040 Camfield Ave
Los Angeles, CA 90040-1501
Phone (323) 622-2429

Other names 1

  • AltaMed Medical and Dental Group-East Los Angeles, 1st Street Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120314000068 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 1 other NPI on this enrollment
Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134492937. Details of each certification follow.

Federally qualified health center certification: CCN 551152

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL AND DENTAL GROUP-EAST LOS ANGELES 1ST STREET
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 29, 2012
Last certification
Jun 29, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
2219 East 1St Street
Los Angeles, CA 90033-3901

Other NPIs with the same Medicare PAC ID 22

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 22

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2044682Altamed Medical & Dental Group2219 E. 1St Street, Los Angeles, CA 90033Certificate of waiverJul 26, 2028

National Provider Directory

National Provider Directory
Tax ID family
Altamed Health Ser117 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2219 E 1st St
Los Angeles, CA 90033
Phone (213) 269-0421

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Maria Grimaldo Individual Corporate DirectorConsumer Board Member Oct 29, 2013
Jose Avalos Individual Corporate DirectorBoard Chairman Jun 28, 2018
Adolfo O Chanez Individual Corporate DirectorBoard Member Feb 25, 2016
Castulo de la Rocha Individual Corporate OfficerPresident & Ceo Mar 1, 1997
Marc Victor Individual Corporate DirectorBoard Treasurer Oct 26, 2017
Ricardo Robles Individual Corporate DirectorBoard Vice Chairman Jan 22, 2015
Victor Olmos Individual Corporate DirectorBoard Member Oct 23, 2020
Joseph Gomez Individual Corporate DirectorConsumer Board Member Sep 6, 2019
Jose Ubaldo Esparza Individual Corporate OfficerSr. Vice President of Finance & Cfo Jan 20, 1994
Robert Young Individual W-2 Managing EmployeeVP, Patient Financial Services Jan 5, 2009
Nadia Paola Alvarez Individual Corporate DirectorConsumer Board Member Sep 6, 2019
Lucy Maria Herrera Individual Corporate DirectorBoard Secretary Oct 25, 2019

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565913600000",
    "number": "1134492937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 CAMFIELD AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900401501",
            "telephone_number": "323-622-2429",
            "fax_number": "323-889-7399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2219 E 1ST ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900333901",
            "telephone_number": "323-269-0424",
            "fax_number": "323-780-9432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTAMED HEALTH SERVICES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-10",
        "last_updated": "2019-08-16",
        "status": "A",
        "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",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AltaMed Medical and Dental Group-East Los Angeles, 1st Street",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AltaMed Medical and Dental Group-East Los Angeles, 1st Street",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.