Basic Information
| Provider Information | |||||||||
| NPI: | 1285380659 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOLDEN STATE CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3091 | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953533091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095754575 | ||||||||
| FaxNumber: | 2095754598 | ||||||||
| Practice Location | |||||||||
| Address1: | 3150 G ST STE E | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953401346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095754575 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2022 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | NANRA | ||||||||
| AuthorizedOfficialFirstName: | JASPREET | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2095754575 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 88-0617451 | 05 | CA | MEDICAID |