Provider Demographics
NPI:1902164395
Name:ALEXANDRA KLIKOFF MD INC, A CALIFORNIA MEDICAL CORPORATION
Entity type:Organization
Organization Name:ALEXANDRA KLIKOFF MD INC, A CALIFORNIA MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-688-8266
Mailing Address - Street 1:3275 APTOS RANCHO RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3983
Mailing Address - Country:US
Mailing Address - Phone:831-688-8266
Mailing Address - Fax:831-688-0811
Practice Address - Street 1:3275 APTOS RANCHO RD
Practice Address - Street 2:SUITE E
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3983
Practice Address - Country:US
Practice Address - Phone:831-688-8266
Practice Address - Fax:831-688-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83647207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG61712Medicare UPIN