Provider Demographics
NPI:1942074786
Name:GOLDEN STATE EPSILON KIDNEY CARE PC
Entity Type:Organization
Organization Name:GOLDEN STATE EPSILON KIDNEY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AWUA-LARBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-608-0563
Mailing Address - Street 1:420 TEHUACAN RD
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-2007
Mailing Address - Country:US
Mailing Address - Phone:609-608-0563
Mailing Address - Fax:877-671-4103
Practice Address - Street 1:390 W STANDLEY ST STE B
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4346
Practice Address - Country:US
Practice Address - Phone:609-608-0563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty