Provider Demographics
NPI:1346312337
Name:GOLDEN STATE NEURO MEDICAL INC.
Entity Type:Organization
Organization Name:GOLDEN STATE NEURO MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:SKALA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:510-657-6366
Mailing Address - Street 1:43575 MISSION BLVD # 707
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5831
Mailing Address - Country:US
Mailing Address - Phone:510-657-6366
Mailing Address - Fax:510-657-3849
Practice Address - Street 1:43575 MISSION BLVD # 707
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5831
Practice Address - Country:US
Practice Address - Phone:510-657-6366
Practice Address - Fax:510-657-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 11658111NX0100X
CAA384842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty