Provider Demographics
NPI:1841616026
Name:GOLDEN WEST MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GOLDEN WEST MEDICAL CORPORATION
Other - Org Name:GOLDEN WEST MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPELOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-634-4884
Mailing Address - Street 1:1000 S. ANAHEIM BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5802
Mailing Address - Country:US
Mailing Address - Phone:714-634-4884
Mailing Address - Fax:714-635-5389
Practice Address - Street 1:1000 S. ANAHEIM BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5802
Practice Address - Country:US
Practice Address - Phone:714-634-4884
Practice Address - Fax:714-635-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426562083X0100X, 261QU0200X, 332900000X
CA68972332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No332900000XSuppliersNon-Pharmacy Dispensing Site