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General NPI Number Information
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NPI Number | 1508012139
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Entity Type | Individual
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Provider Name | MINDY KAYE BIXBY D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 26671 ALISO CREEK RD STE 203
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City | ALISO VIEJO
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State | CA
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Zip | 92656-4810
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Country | US
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Telephone | 949-397-9205
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Fax | 949-955-7259
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Provider Business Mailing Address
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Address Line | 350 FOREST AVE #4258
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City | LAGUNA BEACH
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State | CA
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Zip | 92652-2095
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Country | US
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Telephone | 949-397-9205
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Fax | 949-955-7259
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 00034344
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 20A12872
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License Number State | CA
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