Provider Demographics
NPI:1447444625
Name:ALTOS OAKS MEDICAL GROUP INC
Entity type:Organization
Organization Name:ALTOS OAKS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILONA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-988-7478
Mailing Address - Street 1:2485 HOSPITAL DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4101
Mailing Address - Country:US
Mailing Address - Phone:650-988-7470
Mailing Address - Fax:650-988-7472
Practice Address - Street 1:2485 HOSPITAL DR
Practice Address - Street 2:SUITE 330
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4101
Practice Address - Country:US
Practice Address - Phone:650-988-7470
Practice Address - Fax:650-988-7472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39083Medicare UPIN
CAH57828Medicare UPIN
CAH42223Medicare UPIN
CAF38875Medicare UPIN
CAG19896Medicare UPIN
CAA23485Medicare UPIN
CAA23659Medicare UPIN
CAA41058Medicare UPIN