Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY6420 | FL |
Y | 103TC0700X | Clinical Psychologist | PY6420 | FL |
N | 103TH0100X | Health Service | PY6420 | FL |
NPI | 1013941244 |
---|---|
Provider Name | Dr. Stanley Curtis Takagishi |
First Address | Tampa, FL 33626-1815 |
Second Address | Tampa, FL 33613-4647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 21/09/2020 |