Healthcare Provider Details

I. General information

NPI: 1972903136
Provider Name (Legal Business Name): ANDREW LORAN GOLD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1010 SHANGRILA ST STE 105
KAPOLEI HI
96707-2176
US

IV. Provider business mailing address

980 AE ST APT 301
KAPOLEI HI
96707-3297
US

V. Phone/Fax

Practice location:
  • Phone: 808-377-4300
  • Fax:
Mailing address:
  • Phone: 808-285-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-202435
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: