Healthcare Provider Details

I. General information

NPI: 1336440957
Provider Name (Legal Business Name): ALEKSANDRA NOVIKOV M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4168 FRONT ST
SAN DIEGO CA
92103-2030
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-5743
  • Fax: 619-543-8255
Mailing address:
  • Phone: 619-543-6164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA119627
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA119627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: