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 1:800 S CENTRAL AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4388
Mailing Address - Country:US
Mailing Address - Phone:818-332-2233
Mailing Address - Fax:818-484-5422
Practice Address - Street 1:800 S CENTRAL AVE STE 302
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4388
Practice Address - Country:US
Practice Address - Phone:818-332-2233
Practice Address - Fax:818-484-5422
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41684208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ44181ZOtherB S
CA00A416840Medicaid
CA010061609OtherRAILROAD MEDICARE
CAWA41684AMedicare ID - Type Unspecified
CA00A416840Medicaid
F36626Medicare UPIN