Provider Demographics
NPI:1730136359
Name:GOLD MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:GOLD MEDICAL GROUP, INC.
Other - Org Name:GOLD MEDICAL GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISKANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-264-4114
Mailing Address - Street 1:1700 CESAR E. CHAVEZ
Mailing Address - Street 2:SUITE #3300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-0000
Mailing Address - Country:US
Mailing Address - Phone:323-264-4114
Mailing Address - Fax:323-264-4662
Practice Address - Street 1:1700 CESAR E. CHAVEZ
Practice Address - Street 2:SUITE #3300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-0000
Practice Address - Country:US
Practice Address - Phone:323-264-4114
Practice Address - Fax:323-264-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG186240174400000X
CAA40133207Q00000X
CAA34065207R00000X
CAA44512208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14987Medicare UPIN