MEDICARE: GOLDEN STATE AMBULANCE 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	3416L0300X	Land Ambulance	1639	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	CGP163356	OTHER	CA	CCS

General Provider Information

NPI Number	:	1902811722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN STATE AMBULANCE INC.

Provider Business Mailing Address
First Line	:	3801 CHARTER PARK CT STE E
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95136-1386
Country	:	US
Telephone Number	:	408-445-7400
Fax Number	:	408-445-0474

Provider Business Practice Location Address
First Line	:	3801 CHARTER PARK CT STE E
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95136-1386
Country	:	US
Telephone Number	:	408-445-7400
Fax Number	:	408-445-0474

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAWRENCE R MARSALA
Credential	:
Telephone Number	:	408-445-7400

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	08/22/2020

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