MEDICARE: GOLDEN OAK MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1790424711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN OAK MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	1545 W FLORIDA AVE
Second Line	:
City	:	HEMET
State	:	CA
Zip	:	92543-3814
Country	:	US
Telephone Number	:	951-791-1111
Fax Number	:	888-856-3893

Provider Business Practice Location Address
First Line	:	25485 MEDICAL CENTER DR STE 200
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92562-6927
Country	:	US
Telephone Number	:	951-698-8821
Fax Number	:	888-694-2509

Authorized Official
Title or Position	:	CONTRACTING & CREDENTIALING
Name	:	STEPHANIE LANING
Credential	:
Telephone Number	:	951-791-1111

Provider Enumeration Date	:	05/27/2022
Last Update Date	:	04/13/2026

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