Basic Information
| Provider Information | |||||||||
| NPI: | 1255067377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NITKA | ||||||||
| FirstName: | ALEXA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 MAIN ST APT 214 | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902915233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189122537 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 MEDICAL PLAZA DRIVEWAY STE 430 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107947274 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2022 | ||||||||
| LastUpdateDate: | 07/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | GC001617 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Genetic Counselor, MS |
No ID Information.