Provider Demographics
NPI:1396917548
Name:ALEX GOLD, MD, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ALEX GOLD, MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-453-1386
Mailing Address - Street 1:2021 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 440-E
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2208
Mailing Address - Country:US
Mailing Address - Phone:310-453-1386
Mailing Address - Fax:310-453-4786
Practice Address - Street 1:2021 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 440-E
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2208
Practice Address - Country:US
Practice Address - Phone:310-453-1386
Practice Address - Fax:310-453-4786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2009-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89939261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114924792OtherNPI
CA1114924792OtherNPI
CAI31729Medicare UPIN