GOLDSTAR PEDIATRICS PC NPI 1427420009

NPI Information

  • NPI: 1427420009
  • Provider Name: GOLDSTAR PEDIATRICS PC
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • CLIA Number: 05D2105813
  • Address: 15290 SUMMIT AVE
    SUITE B
    FONTANA, CA
    ZIP 92336
  • Phone: (909) 225-1900

Map and Directions

Get Directions

NPI Details

GOLDSTAR PEDIATRICS PC is a pediatrics in Fontana, CA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. GOLDSTAR PEDIATRICS PC NPI is 1427420009. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

15290 SUMMIT AVE
SUITE B
FONTANA, CA
ZIP 92336-240
Phone: (909) 225-1900

The provider's authorized official is Irmgard Una Tackie .
The authorized official title is Physician/ceo and has the following contact phone number (909) 225-1900.

The CLIA number assigned to this NPI record is 05D2105813 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/22/2015 and was last updated on 12/23/2021.

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
1208000000XPediatricsFNP544821CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
14685141MEDICAIDCALIFORNIA

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

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI