Healthcare Provider Details

I. General information

NPI: 1720904162
Provider Name (Legal Business Name): GOLDEN STATE FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 YOLANDA AVE
TARZANA CA
91356-5967
US

IV. Provider business mailing address

5815 YOLANDA AVE
TARZANA CA
91356-5967
US

V. Phone/Fax

Practice location:
  • Phone: 714-422-4651
  • Fax:
Mailing address:
  • Phone: 714-422-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JAYCOB ANDREW ORNELAS
Title or Position: CEO
Credential:
Phone: 714-422-4651