Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A89939 | CA |
NPI | 1114924792 |
---|---|
Provider Name | Alex Gold |
First Address | Santa Monica, CA 90404-2208 |
Second Address | Santa Monica, CA 90404-2208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 16/08/2010 |