NPIMap

Organization Active NPI

Alta California Medical Group, Inc.

  • Family Medicine Physician
  • Simi Valley, CA
National Provider Identifier
1740290634
Registry record updated Nov 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3270701 Issued in CA
Legal business name
ALTA CALIFORNIA MEDICAL GROUP, INC.
Practice address
2755 Alamo St Ste 201
Simi Valley, CA 93065-1311
Phone
(805) 578-9620
Fax
(805) 955-0498
NPI assigned
Aug 9, 2006
Last updated
Nov 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2023

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

Authorized official

Name
Dr. Alberto Jose Odio, M.D.NPI 1821062316
Title
President
Phone
(805) 578-9620

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 3270701 CA Primary

Addresses

Primary practice location

2755 Alamo St Ste 201
Simi Valley, CA 93065-1311

Mailing address

2925 Sycamore Dr
Suite 204-205
Simi Valley, CA 93065-1207
Phone (805) 578-9620

Other identifiers 1

IdentifierTypeStateIssuer
W14981OtherMEDICARE PTAN

National Provider Directory

National Provider Directory

Locations

2925 Sycamore Dr
#204205
Simi Valley, CA 93065
Phone (805) 578-9620

2925 Sycamore Dr
Ste 204205
Simi Valley, CA 93065
Phone (805) 578-9620

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700784000000",
    "number": "1740290634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 SYCAMORE DR",
            "address_2": "SUITE 204-205",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651207",
            "telephone_number": "805-578-9620",
            "fax_number": "805-955-0498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2755 ALAMO ST STE 201",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651311",
            "telephone_number": "805-578-9620",
            "fax_number": "805-955-0498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTA CALIFORNIA MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2023-11-24",
        "certification_date": "2023-11-24",
        "status": "A",
        "authorized_official_last_name": "ODIO",
        "authorized_official_first_name": "ALBERTO",
        "authorized_official_middle_name": "JOSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-578-9620",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "3270701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "W14981",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Simi Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.