# GOLDEN STATE DERMATOLOGY ASSOCIATES, INC.

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

## Provider details

- **NPI number:** 1235738576
- **Authorized official:** JEFFREY THOMAS BORTZ (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (925) 932-7704

## Contact information

- **Practice address:** 6769 N FRESNO ST, FRESNO, CA 93710-3715
- **Practice address phone:** (559) 435-0337
- **Mailing address:** 355 LENNON LN STE 255, WALNUT CREEK, CA 94598-2496
- **Mailing address phone:** (925) 932-7704

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/19/2020
- **Last updated:** 10/19/2020