Provider Demographics
NPI:1689876732
Name:GOLDEN VALLEY MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:GOLDEN VALLEY MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:VILLAFLOR
Authorized Official - Last Name:VIRTUSIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-468-5757
Mailing Address - Street 1:20957 CURRIER RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3047
Mailing Address - Country:US
Mailing Address - Phone:909-468-5757
Mailing Address - Fax:909-468-5416
Practice Address - Street 1:20957 CURRIER RD
Practice Address - Street 2:SUITE E
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-3047
Practice Address - Country:US
Practice Address - Phone:909-468-5757
Practice Address - Fax:909-468-5416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02362GOtherMEDI-CAL PROVIDER NUMBER
CADME02362GOtherMEDI-CAL PROVIDER NUMBER