Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | A23741 | CA |
NPI | 1639113269 |
---|---|
Provider Name | Richard Taketa |
First Address | Pasadena, CA 91185-1555 |
Second Address | Irvine, CA 92618-3716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 09/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A237410 | (05) | CA |
00A237410 | BLUE SHIELD (01) | CA |
A23662 | (02) |