Healthcare Provider Details

I. General information

NPI: 1295756310
Provider Name (Legal Business Name): GOLDEN VALLEY MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4813 COFFEE RD #200
BAKERSFIELD CA
93308-9472
US

IV. Provider business mailing address

4813 COFFEE RD #200
BAKERSFIELD CA
93308-9472
US

V. Phone/Fax

Practice location:
  • Phone: 661-664-0252
  • Fax: 661-664-2717
Mailing address:
  • Phone: 661-664-0252
  • Fax: 661-664-2717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CALVIN J. KUBO
Title or Position: OWNER
Credential: M.D.
Phone: 661-664-0252