Provider Demographics
NPI:1770653974
Name:GOLD, MARINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:818-507-9431
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:661-367-6175
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41684208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A416840Medicaid
CA010061609OtherRAILROAD MEDICARE
CAZZZ44181ZOtherB S
CAWA41684AMedicare ID - Type Unspecified
CA00A416840Medicaid
F36626Medicare UPIN