Healthcare Provider Details

I. General information

NPI: 1508891797
Provider Name (Legal Business Name): OTASHE GOLDEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 FLORIDA AVE
MODESTO CA
95350-4404
US

IV. Provider business mailing address

1700 MCHENRY AVE STE 65B
MODESTO CA
95350-4333
US

V. Phone/Fax

Practice location:
  • Phone: 209-576-3525
  • Fax: 209-576-3544
Mailing address:
  • Phone: 209-579-5628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number293752
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number207RH0002X
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA70035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: