Provider Demographics
NPI:1215274667
Name:HIXSON, ROXANA YAQUELINE (MD)
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:YAQUELINE
Last Name:HIXSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROXANA
Other - Middle Name:YAQUELINE
Other - Last Name:CORTES LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-8771
Mailing Address - Fax:310-301-8751
Practice Address - Street 1:25775 MCBEAN PKWY STE 215
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3703
Practice Address - Country:US
Practice Address - Phone:661-753-5464
Practice Address - Fax:661-753-5466
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA141254207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty