Healthcare Provider Details

I. General information

NPI: 1730136359
Provider Name (Legal Business Name): GOLD MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CESAR E. CHAVEZ SUITE #3300
LOS ANGELES CA
90033-0000
US

IV. Provider business mailing address

1700 CESAR E. CHAVEZ SUITE #3300
LOS ANGELES CA
90033-0000
US

V. Phone/Fax

Practice location:
  • Phone: 323-264-4114
  • Fax: 323-264-4662
Mailing address:
  • Phone: 323-264-4114
  • Fax: 323-264-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG186240
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA40133
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA44512
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA34065
License Number StateCA

VIII. Authorized Official

Name: ROSANNA ISKANDER
Title or Position: OWNER
Credential: MD
Phone: 323-264-4114