Healthcare Provider Details

I. General information

NPI: 1093661860
Provider Name (Legal Business Name): JODI LEIGH GOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12411 W FIELDING CIR APT 1413
PLAYA VISTA CA
90094-2546
US

IV. Provider business mailing address

12411 W FIELDING CIR APT 1413
PLAYA VISTA CA
90094-2546
US

V. Phone/Fax

Practice location:
  • Phone: 310-981-7718
  • Fax:
Mailing address:
  • Phone: 310-981-7718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number152438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: