Provider Demographics
NPI:1285196998
Name:TAKANIKOS, ALEXANDRA (NP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:TAKANIKOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801280
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1280
Mailing Address - Country:US
Mailing Address - Phone:530-304-8066
Mailing Address - Fax:
Practice Address - Street 1:1800 VINE ST STE 221
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-5250
Practice Address - Country:US
Practice Address - Phone:619-327-9811
Practice Address - Fax:619-352-0970
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily