Healthcare Provider Details

I. General information

NPI: 1609317882
Provider Name (Legal Business Name): NIKA ALEXA VIZCARRA MD, MS, FACOG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 S ATLANTIC BLVD
LOS ANGELES CA
90022-3211
US

IV. Provider business mailing address

607 S ATLANTIC BLVD
LOS ANGELES CA
90022-3211
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-9191
  • Fax: 323-268-9119
Mailing address:
  • Phone: 323-268-9191
  • Fax: 323-268-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA191817
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number21385
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: