| Golden Shore Medical Group | |
|
190 E Highland Ave San Bernardino CA 92404-3658 | |
| (909) 882-4788 | |
| (877) 778-9424 |
| Full Name | Golden Shore Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 190 E Highland Ave, San Bernardino, California |
| Authorized Official Name and Position | Gloria Calderon (VICE PRESIDENT, CLINIC OPERATIONS) |
| Authorized Official Contact | 6263462455 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Golden Shore Medical Group 625 Fair Oaks Ave Ste 270 South Pasadena CA 91030-5801 Ph: (626) 346-2455 | Golden Shore Medical Group 190 E Highland Ave San Bernardino CA 92404-3658 Ph: (909) 882-4788 |
| NPI Number | 1972875680 |
|---|---|
| Provider Enumeration Date | 01/27/2012 |
| Last Update Date | 02/07/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972875680 | NPI | - | NPPES |
| APPROVED EFF 1/31/12 | Medicaid | CA | |
| DU4034-EFF 3/11/12 | Other | CA | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (California) | Primary |
| 208000000X | Pediatrics | (California) | Secondary |
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