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NPI Code Detail

MEDICARE: DR. BRIAN DOUGLAS GOLD PH.D.

MEDICARE: DR. BRIAN DOUGLAS GOLD PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPSY10601CA
2103TC0700XClinical PsychologistPSY10601CA

General Provider Information

NPI Number : 1962415489
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN DOUGLAS GOLD PH.D.
Provider Business Mailing Address
First Line : 6330 SAN VICENTE BLVD
Second Line : SUITE 520
City : LOS ANGELES
State : CA
Zip : 90048-5455
Country : US
Telephone Number : 310-274-2843
Fax Number :
Provider Business Practice Location Address
First Line : 6330 SAN VICENTE BLVD
Second Line : SUITE 520
City : LOS ANGELES
State : CA
Zip : 90048-5455
Country : US
Telephone Number : 310-274-2843
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2006
Last Update Date : 08/07/2023

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