Provider Demographics
NPI:1770573065
Name:GOLDEN MEDICAL SERVICES
Entity type:Organization
Organization Name:GOLDEN MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ITA
Authorized Official - Middle Name:EYO
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:909-889-9944
Mailing Address - Street 1:1485 N WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-5358
Mailing Address - Country:US
Mailing Address - Phone:909-889-9944
Mailing Address - Fax:909-889-9811
Practice Address - Street 1:1485 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5358
Practice Address - Country:US
Practice Address - Phone:909-889-9944
Practice Address - Fax:909-889-9811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1291320001Medicare NSC