Provider Demographics
NPI:1225800667
Name:PACIFIC GOLDEN GATE LLC
Entity Type:Organization
Organization Name:PACIFIC GOLDEN GATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BAHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FADUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-779-5613
Mailing Address - Street 1:5421 SHADOW STONE ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-4321
Mailing Address - Country:US
Mailing Address - Phone:661-779-5613
Mailing Address - Fax:
Practice Address - Street 1:5421 SHADOW STONE ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-4321
Practice Address - Country:US
Practice Address - Phone:661-779-5613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)