# GOLDEN STATE PRIMARY CARE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124987201
- **Authorized official:** NAMITA MOHIDEEN MD (CEO)
- **Authorized official phone:** (909) 823-8000

## Contact information

- **Practice address:** 16465 SIERRA LAKES PKWY STE 115, FONTANA, CA 92336-1242
- **Practice address phone:** (909) 823-8000
- **Practice address fax:** (909) 823-8088
- **Mailing address:** 16465 SIERRA LAKES PKWY STE 115, FONTANA, CA 92336-1242
- **Mailing address phone:** (909) 823-8000
- **Mailing address fax:** (909) 823-8088

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/15/2026
- **Last updated:** 01/15/2026