Provider Demographics
NPI:1124839139
Name:GOLDEN STATE FAMILY CLINIC
Entity type:Organization
Organization Name:GOLDEN STATE FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:TABAIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-290-0844
Mailing Address - Street 1:5475 E LA PALMA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2075
Mailing Address - Country:US
Mailing Address - Phone:323-264-2670
Mailing Address - Fax:
Practice Address - Street 1:5475 E LA PALMA AVE STE 204
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2075
Practice Address - Country:US
Practice Address - Phone:323-264-2670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty