| Alta California Medical Group, Inc. | |
|
2755 Alamo St Ste 201 Simi Valley CA 93065-1311 | |
| (805) 578-9620 | |
| (805) 955-0498 |
| Full Name | Alta California Medical Group, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 2755 Alamo St Ste 201, Simi Valley, California |
| Authorized Official Name and Position | Alberto Jose Odio (PRESIDENT) |
| Authorized Official Contact | 8055789620 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alta California Medical Group, Inc. 2925 Sycamore Dr Suite 204-205 Simi Valley CA 93065-1207 Ph: (805) 578-9620 | Alta California Medical Group, Inc. 2755 Alamo St Ste 201 Simi Valley CA 93065-1311 Ph: (805) 578-9620 |
| NPI Number | 1740290634 |
|---|---|
| Provider Enumeration Date | 08/09/2006 |
| Last Update Date | 11/24/2023 |
| Medicare PECOS PAC ID | 1658308507 |
|---|---|
| Medicare Enrollment ID | O20050721000788 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740290634 | NPI | - | NPPES |
| W14981 | Other | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 3270701 (California) | Primary |
| Provider Name | Masahiro Kushigemachi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386617058 PECOS PAC ID: 7113054669 Enrollment ID: I20110217000312 |
| Provider Name | Alberto Jose Odio |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821062316 PECOS PAC ID: 4587791033 Enrollment ID: I20110217000326 |
| Provider Name | Emelia Perez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710393350 PECOS PAC ID: 7315220621 Enrollment ID: I20181030000719 |
| Provider Name | Brittany Zeigler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639801376 PECOS PAC ID: 7214305317 Enrollment ID: I20221121002922 |
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