Organization
GOLDEN STATE OTOLARYNGOLOGY MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUWANTHI CAMPANO MD (CEO)
(661) 726-6277
Entity
Organization
Contact information
Practice address
41301 12TH ST W, SUITE A, PALMDALE, CA 93551-1464
(661) 726-6277
(661) 726-6291
Mailing address
41301 12TH ST W, SUITE A, PALMDALE, CA 93551-1464
(661) 726-6277
(661) 726-6291
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A69121
CA
Other
Enumeration date
08/08/2014
Last updated
08/08/2014
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