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General NPI Number Information
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NPI Number | 1578345625
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Entity Type | Organization
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Legal Business Name | GOLDEN STATE FAMILY CLINIC
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Dates
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Enumeration Date | 10/13/2023
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 4082 WHITTIER BLVD STE 102
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City | LOS ANGELES
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State | CA
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Zip | 90023-2559
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Country | US
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Telephone | 323-347-5757
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Fax | 323-264-2671
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Provider Business Mailing Address
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Address Line | PO BOX 18025
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City | ANAHEIM
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State | CA
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Zip | 92817-8025
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Country | US
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Telephone | 941-720-0731
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HAROLD TABAIE
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Credential | DO
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Telephone | 941-720-0731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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