Organization
ALTA CALIFORNIA MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALBERTO JOSE ODIO M.D. (PRESIDENT)
(805) 578-9620
Entity
Organization
Contact information
Practice address
2755 ALAMO ST STE 201, SIMI VALLEY, CA 93065-1311
(805) 578-9620
(805) 955-0498
Mailing address
2925 SYCAMORE DR, SUITE 204-205, SIMI VALLEY, CA 93065-1207
(805) 578-9620
(805) 955-0498
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3270701
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W14981
MEDICARE PTAN
—
Enumeration date
08/09/2006
Last updated
11/24/2023
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