=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124678685
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDEN STATE MEDICAL PARTNERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2019
-----------------------------------------------------
Last Update Date | 09/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39830 PORTOLA AVE
-----------------------------------------------------
City | PALM DESERT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92260-0623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-206-3645
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39830 PORTOLA AVE
-----------------------------------------------------
City | PALM DESERT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92260-0623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-206-3645
-----------------------------------------------------
Fax | 760-972-4586
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL PARTNER
-----------------------------------------------------
Name | RAJ SINHA
-----------------------------------------------------
Credential | MD, PHD
-----------------------------------------------------
Telephone | 760-989-0597
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------