Provider Demographics
NPI:1245253210
Name:BICKMAN, TRISTAN EMILY (MD)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:EMILY
Last Name:BICKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1245 16TH ST
Mailing Address - Street 2:STE 312
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1239
Mailing Address - Country:US
Mailing Address - Phone:310-453-1982
Mailing Address - Fax:310-829-4942
Practice Address - Street 1:1245 16TH ST
Practice Address - Street 2:STE 312
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1239
Practice Address - Country:US
Practice Address - Phone:310-453-1982
Practice Address - Fax:310-829-4942
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA016840207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology