MEDICARE: ALEXANDRA TAKANIKOS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95011451	CA

General Provider Information

NPI Number	:	1285196998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA TAKANIKOS NP

Provider Business Mailing Address
First Line	:	PO BOX 801280
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-1280
Country	:	US
Telephone Number	:	530-304-8066
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 VINE ST STE 221
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5250
Country	:	US
Telephone Number	:	619-327-9811
Fax Number	:	619-352-0970

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	08/08/2024

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