Healthcare Provider Details

I. General information

NPI: 1750772141
Provider Name (Legal Business Name): GOLDEN STATE MANAGEMENT GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2015
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 HORIZON DR STE 103
FAIRFIELD CA
94533-1688
US

IV. Provider business mailing address

1101 HORIZON DR STE 103
FAIRFIELD CA
94533-1688
US

V. Phone/Fax

Practice location:
  • Phone: 510-778-0022
  • Fax: 510-232-2338
Mailing address:
  • Phone: 510-778-0022
  • Fax: 510-232-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. NIRMALJIT SINGH
Title or Position: PRESIDENT
Credential:
Phone: 510-778-0022