Provider Demographics
NPI:1407285240
Name:GOLDEN STATE DERMATOLOGY, INC.
Entity Type:Organization
Organization Name:GOLDEN STATE DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-945-7005
Mailing Address - Street 1:2255 YGNACIO VALLEY RD.
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3335
Mailing Address - Country:US
Mailing Address - Phone:925-945-7005
Mailing Address - Fax:925-236-2784
Practice Address - Street 1:2255 YGNACIO VALLEY RD STE B1
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3335
Practice Address - Country:US
Practice Address - Phone:925-945-1127
Practice Address - Fax:925-945-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty