Provider Demographics
NPI:1356450423
Name:GOLDEN VALLEY MEDICAL & OXYGEN SERVICE
Entity Type:Organization
Organization Name:GOLDEN VALLEY MEDICAL & OXYGEN SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO /PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOBBITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-884-0445
Mailing Address - Street 1:424 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-4014
Mailing Address - Country:US
Mailing Address - Phone:909-884-0445
Mailing Address - Fax:909-882-6358
Practice Address - Street 1:424 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-4014
Practice Address - Country:US
Practice Address - Phone:909-884-0445
Practice Address - Fax:909-882-6358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM66550332B00000X, 332BC3200X, 332BX2000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ40719ZMedicaid
CAZZZ40719ZMedicaid