Provider Demographics
NPI:1477979656
Name:FIKHMAN, SIMONA ALEXANDRA
Entity Type:Individual
Prefix:
First Name:SIMONA
Middle Name:ALEXANDRA
Last Name:FIKHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 LAUREL CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-4921
Mailing Address - Country:US
Mailing Address - Phone:818-505-9300
Mailing Address - Fax:
Practice Address - Street 1:3959 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-4921
Practice Address - Country:US
Practice Address - Phone:818-505-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51462363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical