1558413732 NPI number — DR. VIRGINIA YVONNE GOLD EDD DOCTOR OF EDUCAT

Table of content: DR. VIRGINIA YVONNE GOLD EDD DOCTOR OF EDUCAT (NPI 1558413732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558413732 NPI number — DR. VIRGINIA YVONNE GOLD EDD DOCTOR OF EDUCAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLD
Provider First Name:
VIRGINIA
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
EDD DOCTOR OF EDUCAT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558413732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 MARNA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-431-0817
Provider Business Mailing Address Fax Number:
562-431-0817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3551 FLORISTA ST
Provider Second Line Business Practice Location Address:
SUITE 1D
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-431-5600
Provider Business Practice Location Address Fax Number:
562-431-0817
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFT7688 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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