Healthcare Provider Details

I. General information

NPI: 1205911245
Provider Name (Legal Business Name): ANDREA GOLD RN CFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WASHINGTON ST SUITE 700
SAN DIEGO CA
92103-2231
US

IV. Provider business mailing address

501 WASHINGTON ST SUITE 700
SAN DIEGO CA
92103-2231
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-4481
  • Fax: 619-291-5536
Mailing address:
  • Phone: 619-297-4481
  • Fax: 619-291-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number207694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: