Provider Demographics
NPI:1891180410
Name:GOLD, MARIYA (NP)
Entity Type:Individual
Prefix:
First Name:MARIYA
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARIYA
Other - Middle Name:
Other - Last Name:ZALESSKAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2525 W GREENWAY RD STE 230
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6593
Mailing Address - Country:US
Mailing Address - Phone:480-573-0886
Mailing Address - Fax:480-573-0883
Practice Address - Street 1:2525 W GREENWAY RD STE 230
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-6593
Practice Address - Country:US
Practice Address - Phone:480-573-0886
Practice Address - Fax:480-573-0883
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307262363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner