Healthcare Provider Details

I. General information

NPI: 1649632696
Provider Name (Legal Business Name): NIKITA VASHI BACLIG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKITA VASHI

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SANTA MONICA BLVD STE 580
SANTA MONICA CA
90404-2000
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-5471
  • Fax:
Mailing address:
  • Phone: 310-301-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60874954
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number168697
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA168697
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA168697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: