Provider Demographics
NPI:1093814113
Name:PC MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:PC MEDICAL CLINIC INC
Other - Org Name:MARINA GOLD MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-293-1177
Mailing Address - Street 1:27141 HIDAWAY AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-4147
Mailing Address - Country:US
Mailing Address - Phone:661-397-1177
Mailing Address - Fax:661-367-6175
Practice Address - Street 1:27141 HIDAWAY AVE STE 204
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-4147
Practice Address - Country:US
Practice Address - Phone:661-397-1177
Practice Address - Fax:661-397-6175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0069470Medicaid
CA010061609OtherRAILROAD MEDICARE
CAZZZ44181ZOtherBLUE SHIELD
CA00A416840Medicaid
CAW13299AMedicare ID - Type Unspecified
CAZZZ44181ZOtherBLUE SHIELD
CAGR0069470Medicaid