Healthcare Provider Details

I. General information

NPI: 1548619331
Provider Name (Legal Business Name): NATALIE GOLD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N. SAN FERNANDO RD
BURBANK CA
91502
US

IV. Provider business mailing address

140 N SAN FERNANDO BLVD
BURBANK CA
91502-1207
US

V. Phone/Fax

Practice location:
  • Phone: 818-926-9156
  • Fax:
Mailing address:
  • Phone: 818-926-9156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number53938
License Number StateCA

VIII. Authorized Official

Name: MS. KARINA NAZARIAN
Title or Position: PRESIDENT
Credential:
Phone: 818-926-9156