| Otashe Golden, Md, Inc. | |
|
9098 Laguna Main St Suite 6 Elk Grove CA 95758-7449 | |
| (916) 691-6780 | |
| (916) 691-6799 |
| Full Name | Otashe Golden, Md, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 9098 Laguna Main St, Elk Grove, California |
| Authorized Official Name and Position | Otashe Nyoku Golden (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9166916780 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Otashe Golden, Md, Inc. 9098 Laguna Main St Suite 6 Elk Grove CA 95758-7449 Ph: (916) 691-6780 | Otashe Golden, Md, Inc. 9098 Laguna Main St Suite 6 Elk Grove CA 95758-7449 Ph: (916) 691-6780 |
| NPI Number | 1912165598 |
|---|---|
| Provider Enumeration Date | 05/30/2008 |
| Last Update Date | 03/18/2009 |
| Medicare PECOS PAC ID | 4880021393 |
|---|---|
| Medicare Enrollment ID | O20200224000327 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912165598 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Otashe Golden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508891797 PECOS PAC ID: 9436152774 Enrollment ID: I20060807000240 |
| Provider Name | Penny Dawn Greaves |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710420807 PECOS PAC ID: 4688957608 Enrollment ID: I20170216001321 |
| Provider Name | Bernarde M Udo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447779889 PECOS PAC ID: 9335179563 Enrollment ID: I20180413001384 |
| Provider Name | Dixie Tucker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710331020 PECOS PAC ID: 5698067684 Enrollment ID: I20190328000326 |
| Provider Name | Nakia Antoinette Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548725310 PECOS PAC ID: 4082947643 Enrollment ID: I20190613000972 |
| Provider Name | Thuy Thi Phan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881103976 PECOS PAC ID: 0547660136 Enrollment ID: I20210618001812 |
| Provider Name | Marshe Ivy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386308955 PECOS PAC ID: 6608252655 Enrollment ID: I20220929000271 |
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