Provider Demographics
NPI:1780338491
Name:GOLDCARE MEDICAL SUPPLY
Entity type:Organization
Organization Name:GOLDCARE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AZAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLCHIN MOGHADDAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-547-5537
Mailing Address - Street 1:1 PETERS CANYON RD STE 160
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1748
Mailing Address - Country:US
Mailing Address - Phone:949-547-5537
Mailing Address - Fax:
Practice Address - Street 1:1 PETERS CANYON RD STE 160
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-1748
Practice Address - Country:US
Practice Address - Phone:949-547-5537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies