Provider Demographics
NPI:1285380659
Name:GOLDEN STATE CARE PC
Entity type:Organization
Organization Name:GOLDEN STATE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:NANRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-575-4575
Mailing Address - Street 1:PO BOX 3091
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95353-3091
Mailing Address - Country:US
Mailing Address - Phone:209-575-4575
Mailing Address - Fax:209-575-4598
Practice Address - Street 1:3150 G ST STE E
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-1346
Practice Address - Country:US
Practice Address - Phone:209-575-4575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA88-0617451Medicaid