Provider Demographics
NPI:1467333732
Name:ALTA SALUD
Entity type:Organization
Organization Name:ALTA SALUD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAGOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-398-6706
Mailing Address - Street 1:12099 W WASHINGTON BLVD STE 412
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-2620
Mailing Address - Country:US
Mailing Address - Phone:310-398-6706
Mailing Address - Fax:310-398-5189
Practice Address - Street 1:12099 W WASHINGTON BLVD STE 412
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2620
Practice Address - Country:US
Practice Address - Phone:310-398-6706
Practice Address - Fax:310-398-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty