Provider Demographics
NPI:1992154975
Name:ALTERRA MED, INC.
Entity type:Organization
Organization Name:ALTERRA MED, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALKCOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-847-5883
Mailing Address - Street 1:11741 VALLEY VIEW ST STE A
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5500
Mailing Address - Country:US
Mailing Address - Phone:714-897-1071
Mailing Address - Fax:714-373-4696
Practice Address - Street 1:11741 VALLEY VIEW ST STE A
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5500
Practice Address - Country:US
Practice Address - Phone:714-897-1071
Practice Address - Fax:714-373-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty