Organization
GOLDEN STATE OTOLARYNGOLOGY MEDICAL CORPORATION
Active
Other names
GSOMC-Billing
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RUWANTHI S CAMPANO M.D. (PRESIDENT)
(661) 726-6277
Entity
Organization
Contact information
Practice address
44105 15TH ST W STE 202, LANCASTER, CA 93534-4090
(661) 726-6277
(661) 726-6291
Mailing address
PO BOX 6558, LANCASTER, CA 93539-6558
(661) 726-6277
(661) 726-6291
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A69121
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ64933Z
BLUE SHIELD
CA
Enumeration date
07/10/2007
Last updated
02/11/2008
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