Healthcare Provider Details

I. General information

NPI: 1720089584
Provider Name (Legal Business Name): GOLDEN YEARS MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 DU BOIS ST SUITE C
SAN RAFAEL CA
94901-3944
US

IV. Provider business mailing address

625 DU BOIS ST SUITE C
SAN RAFAEL CA
94901-3944
US

V. Phone/Fax

Practice location:
  • Phone: 415-453-6500
  • Fax: 415-453-6505
Mailing address:
  • Phone: 415-453-6500
  • Fax: 415-453-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number8531
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number070592001
License Number StateCA

VIII. Authorized Official

Name: RONNIE NAIKER
Title or Position: CEO
Credential:
Phone: 415-453-6500