Individual
LARA GOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
68 12TH ST, SUITE 200, SAN FRANCISCO, CA 94103-1297
(415) 905-5050
Mailing address
68 12TH ST, SUITE 200, SAN FRANCISCO, CA 94103-1297
(415) 905-5050
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922259548
MCE
CA
Enumeration date
11/23/2011
Last updated
05/01/2013
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