Provider Demographics
NPI:1508012139
Name:BIXBY, MINDY KAYE (DO)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:KAYE
Last Name:BIXBY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 FOREST AVE #4258
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92652-2095
Mailing Address - Country:US
Mailing Address - Phone:949-397-9205
Mailing Address - Fax:949-955-7259
Practice Address - Street 1:26671 ALISO CREEK RD STE 203
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-4810
Practice Address - Country:US
Practice Address - Phone:949-397-9205
Practice Address - Fax:949-955-7259
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DC000343442084N0400X
CA20A128722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty