Provider Demographics
NPI:1902291776
Name:HAKIMIAN, TINA R (MD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:R
Last Name:HAKIMIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N LA CIENEGA BLVD STE 219
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2246
Mailing Address - Country:US
Mailing Address - Phone:310-652-6060
Mailing Address - Fax:
Practice Address - Street 1:50 N LA CIENEGA BLVD STE 219
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2246
Practice Address - Country:US
Practice Address - Phone:310-652-6060
Practice Address - Fax:310-652-6607
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA159441208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program