Healthcare Provider Details

I. General information

NPI: 1356450423
Provider Name (Legal Business Name): GOLDEN VALLEY MEDICAL & OXYGEN SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 W HIGHLAND AVE
SAN BERNARDINO CA
92405-4014
US

IV. Provider business mailing address

424 W HIGHLAND AVE
SAN BERNARDINO CA
92405-4014
US

V. Phone/Fax

Practice location:
  • Phone: 909-884-0445
  • Fax: 909-882-6358
Mailing address:
  • Phone: 909-884-0445
  • Fax: 909-882-6358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberM66550
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberM66550
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberM66550
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberM66550
License Number StateCA

VIII. Authorized Official

Name: PATRICIA ANN BOBBITT
Title or Position: CEO /PRESIDENT
Credential:
Phone: 909-884-0445