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General NPI Number Information
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NPI Number | 1760083646
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Entity Type | Organization
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Legal Business Name | GOLDEN COAST MSO, INC.
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 590 N SIERRA WAY
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City | SAN BERNARDINO
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State | CA
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Zip | 92410-4817
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Country | US
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Telephone | 909-461-1515
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Fax | 833-606-1238
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Provider Business Mailing Address
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Address Line | 590 N SIERRA WAY
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City | SAN BERNARDINO
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State | CA
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Zip | 92410-4817
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Country | US
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Telephone | 909-461-1515
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Fax | 833-606-1238
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Authorized Official
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Title or Position | OPERATIONS
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Name | ALEX PARTAL
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Credential |
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Telephone | 909-461-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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