Provider Demographics
NPI:1891458121
Name:GOLDEN STATE PAIN SOLUTIONS INC
Entity Type:Organization
Organization Name:GOLDEN STATE PAIN SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-999-0670
Mailing Address - Street 1:8341 FAIR OAKS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1905
Mailing Address - Country:US
Mailing Address - Phone:916-999-0670
Mailing Address - Fax:
Practice Address - Street 1:8341 FAIR OAKS BLVD STE C
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1905
Practice Address - Country:US
Practice Address - Phone:916-999-0670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain