MEDICARE: ALEXIS NIXON PA

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
1	363AM0700X	Medical Physician Assistant	A14878	CA

General Provider Information

NPI Number	:	1699713966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS NIXON PA

Provider Business Mailing Address
First Line	:	1103 S HUDSON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-1807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6245 DE LONGPRE AVE
Second Line	:	206
City	:	HOLLYWOOD
State	:	CA
Zip	:	90028-8253
Country	:	US
Telephone Number	:	323-785-1223
Fax Number	:	323-785-1282

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	02/21/2013

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Directions to “ ALEXIS NIXON PA” Practice Location

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