| Golden State Family Clinic | |
|
4082 Whittier Blvd Ste 102 Los Angeles CA 90023-2559 | |
| (323) 347-5757 | |
| (323) 264-2671 |
| Full Name | Golden State Family Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 4082 Whittier Blvd Ste 102, Los Angeles, California |
| Authorized Official Name and Position | Harold Tabaie (CEO) |
| Authorized Official Contact | 9417200731 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Golden State Family Clinic Po Box 18025 Anaheim CA 92817-8025 Ph: (941) 720-0731 | Golden State Family Clinic 4082 Whittier Blvd Ste 102 Los Angeles CA 90023-2559 Ph: (323) 347-5757 |
| NPI Number | 1578345625 |
|---|---|
| Provider Enumeration Date | 10/13/2023 |
| Last Update Date | 10/13/2023 |
| Medicare PECOS PAC ID | 2466805296 |
|---|---|
| Medicare Enrollment ID | O20240129002739 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578345625 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Alfred Glover |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1205981859 PECOS PAC ID: 7012967110 Enrollment ID: I20050126000875 |
| Provider Name | Harold A Tabaie |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1346286663 PECOS PAC ID: 6507991395 Enrollment ID: I20100318000486 |
| Provider Name | Juan I Sam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033278031 PECOS PAC ID: 0345427449 Enrollment ID: I20110526000402 |
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