Healthcare Provider Details

I. General information

NPI: 1427214378
Provider Name (Legal Business Name): SAMIRA NIKSEFAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N BRAND BLVD STE L
GLENDALE CA
91202-3070
US

IV. Provider business mailing address

5000 CHESHIRE PKWY N
PLYMOUTH MN
55446-4103
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-7653
  • Fax: 818-244-3229
Mailing address:
  • Phone: 888-510-0766
  • Fax: 763-268-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU2206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: