Healthcare Provider Details

I. General information

NPI: 1093814113
Provider Name (Legal Business Name): PC MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/02/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27141 HIDAWAY AVE STE 204
SANTA CLARITA CA
91351-4147
US

IV. Provider business mailing address

27141 HIDAWAY AVE STE 204
SANTA CLARITA CA
91351-4147
US

V. Phone/Fax

Practice location:
  • Phone: 661-397-1177
  • Fax: 661-397-6175
Mailing address:
  • Phone: 661-397-1177
  • Fax: 661-367-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MARINA GOLD
Title or Position: OWNER
Credential: MD
Phone: 661-293-1177