Healthcare Provider Details

I. General information

NPI: 1568227445
Provider Name (Legal Business Name): GOLDEN STATE BEHAVIOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 STONEHURST DR
MARTINEZ CA
94553-9721
US

IV. Provider business mailing address

5360 STONEHURST DR
MARTINEZ CA
94553-9721
US

V. Phone/Fax

Practice location:
  • Phone: 510-501-2385
  • Fax: 510-495-1113
Mailing address:
  • Phone: 510-501-2385
  • Fax: 510-495-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: LUIS RICARDO ARMENTA GOMEZ
Title or Position: MANAGING MEMBER
Credential: BCBA
Phone: 510-501-2385