Basic Information
| Provider Information | |||||||||
| NPI: | 1427214378 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIKSEFAT | ||||||||
| FirstName: | SAMIRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 CHESHIRE PKWY N | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554464103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885100766 | ||||||||
| FaxNumber: | 7632684030 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 N BRAND BLVD | ||||||||
| Address2: | STE L | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912023070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182447653 | ||||||||
| FaxNumber: | 8182443229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2008 | ||||||||
| LastUpdateDate: | 05/19/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AU2206 | CA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.