| Golden Shore Medical Group | |
|
14544 7th St Victorville CA 92395-4214 | |
| (562) 499-6191 | |
| (562) 499-6191 |
| Full Name | Golden Shore Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 14544 7th St, Victorville, 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 14544 7th St Victorville CA 92395-4214 Ph: (562) 499-6191 |
| NPI Number | 1518300912 |
|---|---|
| Provider Enumeration Date | 04/16/2013 |
| Last Update Date | 02/07/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518300912 | NPI | - | NPPES |
| DU5182-EFF 8/5/13 | Other | CA | RAILROAD MEDICARE |
| EFF: 10/21/13 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
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