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NPI Code Detail

MEDICARE: ALEXANDER PANIS NP

MEDICARE: ALEXANDER PANIS NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner95005025CA

General Provider Information

NPI Number : 1154871184
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDER PANIS NP
Provider Business Mailing Address
First Line : 111 N SEPULVEDA BLVD STE 210
Second Line :
City : MANHATTAN BEACH
State : CA
Zip : 90266-6849
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 111 N SEPULVEDA BLVD STE 210
Second Line :
City : MANHATTAN BEACH
State : CA
Zip : 90266-6849
Country : US
Telephone Number : 424-241-1557
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2016
Last Update Date : 10/13/2016

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