Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | V8013314 | CA |
NPI | 1841229820 |
---|---|
Provider Name | Dr. Charles R. Taksa |
First Address | Hanford, CA 93230-3500 |
Second Address | Hanford, CA 93230-3785 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 15/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G363501 | (05) | CA |
A46656 | (02) | CA |
G363501 | STATE LICENSE (01) | CA |