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General NPI Number Information
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NPI Number | 1689729758
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Entity Type | Individual
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Provider Name | JESSICA L. GOLD D.C., P.T.A
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Gender | Female
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 07/01/2014
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Provider Practice Location Address
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Address Line | 733 GREENBRIAR CIRCLE
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City | PETALUMA
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State | CA
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Zip | 94954
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Country | US
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Telephone | 760-213-0506
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Fax |
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Provider Business Mailing Address
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Address Line | 733 GREENBRIAR CIR
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City | PETALUMA
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State | CA
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Zip | 94954-3543
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Country | US
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Telephone | 760-213-0506
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC28890
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | AT5090
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License Number State | CA
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