Provider Demographics
NPI:1629219530
Name:NIKSEFAT, SANAZ (PMHNP)
Entity Type:Individual
Prefix:
First Name:SANAZ
Middle Name:
Last Name:NIKSEFAT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 S BEVERLY GLEN BLVD UNIT 301
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5180
Mailing Address - Country:US
Mailing Address - Phone:310-913-2229
Mailing Address - Fax:
Practice Address - Street 1:2010 S BEVERLY GLEN BLVD UNIT 301
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5180
Practice Address - Country:US
Practice Address - Phone:310-913-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930129133V00000X
CA95027406363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered