Provider Demographics
NPI:1902613805
Name:GOLDEN ROSE PGX LLC
Entity type:Organization
Organization Name:GOLDEN ROSE PGX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-339-5826
Mailing Address - Street 1:4148 SALLY RIDE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-4001
Mailing Address - Country:US
Mailing Address - Phone:925-339-5826
Mailing Address - Fax:916-403-7198
Practice Address - Street 1:4070 BASELINE RD STE 110
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-6489
Practice Address - Country:US
Practice Address - Phone:925-339-5826
Practice Address - Fax:916-403-7198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-13
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center