Provider Demographics
NPI:1972743086
Name:GOLD, MARLO R (OTR)
Entity Type:Individual
Prefix:
First Name:MARLO
Middle Name:R
Last Name:GOLD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MARLO
Other - Middle Name:R
Other - Last Name:PRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3140 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2108
Mailing Address - Country:US
Mailing Address - Phone:760-720-9898
Mailing Address - Fax:
Practice Address - Street 1:3140 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2108
Practice Address - Country:US
Practice Address - Phone:760-720-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6937314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility