Provider Demographics
NPI:1649632696
Name:BACLIG, NIKITA VASHI (MD)
Entity type:Individual
Prefix:MS
First Name:NIKITA
Middle Name:VASHI
Last Name:BACLIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIKITA
Other - Middle Name:
Other - Last Name:VASHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:CHS 60-054
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095
Mailing Address - Country:US
Mailing Address - Phone:310-794-8349
Mailing Address - Fax:
Practice Address - Street 1:10833 LE CONTE AVE.
Practice Address - Street 2:CHS 60-054
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-794-8349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60874954207R00000X
CA168697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1649632696Medicaid