Provider Demographics
NPI:1689728487
Name:GOLD, MARCIA NORMA (RN GNP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:NORMA
Last Name:GOLD
Suffix:
Gender:F
Credentials:RN GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 W OLYMPIC BLVD
Mailing Address - Street 2:#301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4664
Mailing Address - Country:US
Mailing Address - Phone:323-931-3100
Mailing Address - Fax:323-931-0030
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:#301
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4664
Practice Address - Country:US
Practice Address - Phone:323-931-3100
Practice Address - Fax:323-931-0030
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA441913163W00000X
CA4493363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11213Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
S50446Medicare UPIN