Basic Information
| Provider Information | |||||||||
| NPI: | 1134469026 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAKAS | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | FNP-C, RNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3431 COUNTRY CLUB DR | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912081155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185227622 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2001 SANTA MONICA BLVD STE 760W | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105827474 | ||||||||
| FaxNumber: | 3105827481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2013 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | 601949 | CA | N | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant | 363L00000X | NP95003467 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.