Provider Demographics
NPI:1861923450
Name:NIXON, KHAULA
Entity type:Individual
Prefix:
First Name:KHAULA
Middle Name:
Last Name:NIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3875
Mailing Address - Country:US
Mailing Address - Phone:916-395-4453
Mailing Address - Fax:916-395-4454
Practice Address - Street 1:1104 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3875
Practice Address - Country:US
Practice Address - Phone:916-395-4453
Practice Address - Fax:916-395-4454
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200708210359172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver