Golden Age Medical Group, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

GOLDEN AGE MEDICAL GROUP, INC

Practice address

16498 Victor St
Victorville, CA 92395-3918

Phone

(760) 951-3323

Fax

(760) 951-3322

NPI assigned

Apr 3, 2020

Last updated

Apr 3, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ruth Chambi -Hernandez, MD

Title

Ceo

Phone

(760) 951-3323

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585872000000",
    "number": "1437788361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16498 VICTOR ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923953918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16498 VICTOR ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923953918",
            "telephone_number": "760-951-3323",
            "fax_number": "760-951-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN AGE MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-03",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "status": "A",
        "authorized_official_last_name": "CHAMBI -HERNANDEZ",
        "authorized_official_first_name": "RUTH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-951-3323",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Victorville, CA
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• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.