Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 53140 | CA |
Y | 213EG0000X | General Practice | 53140 | CA |
NPI | 1003891748 |
---|---|
Provider Name | Dr. Raynese S. Fikes |
First Address | Point Mugu Nawc, CA 93042-0001 |
Second Address | Point Mugu Nawc, CA 93042-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 08/07/2007 |