GOLDEN STATE PRIMARY CARE INC NPI 1124987201

NPI Information

  • NPI: 1124987201
  • Provider Name: GOLDEN STATE PRIMARY CARE INC
  • Classification: General Practice - 208D00000X
  • Entity Type: Organization
  • Address: 16465 SIERRA LAKES PKWY STE 115
    FONTANA, CA
    ZIP 92336
  • Phone: (909) 823-8000

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NPI Details

GOLDEN STATE PRIMARY CARE INC is a general practice in Fontana, CA. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee GOLDEN STATE PRIMARY CARE INC NPI is 1124987201. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

16465 SIERRA LAKES PKWY STE 115
FONTANA, CA
ZIP 92336-242
Phone: (909) 823-8000
Fax: (909) 823-8088

The provider's authorized official is Namita Mohideen .
The authorized official title is Ceo and has the following contact phone number (909) 823-8000.

The enumeration date for this NPI number is 1/15/2026 and was last updated on 1/15/2026.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YM0800XCounselorMental HealthNo
2207Q00000XFamily MedicineNo
3207R00000XInternal MedicineNo
4208000000XPediatricsNo
5208D00000XGeneral PracticeYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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