1437260825 NPI number — FERN S. TAKEMOTO M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437260825 NPI number — FERN S. TAKEMOTO M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

TAKEMOTO

Provider First Name:

FERN

Provider Middle Name:

S.

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1437260825

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/13/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3400 DATA DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

RANCHO CORDOVA

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

95670-7956

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

6555 COYLE AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CARMICHAEL

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

95608-0302

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

916-733-3333

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

08/31/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208000000X , with the licence number:  G71709 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 90026157 . This is a "PACIFICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 000810342982 . This is a "PHCS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 00G717090 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: 016914 . This is a "HEALTH NET" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 3822049 . This is a "CIGNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 4509750 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: G71709 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 18634 . This is a "INTERPLAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 1062717 . This is a "FIRST HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: MCMG126500 . This is a "WESTERN HEALTH ADVANTAGE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 1089896 . This is a "GREAT WEST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 1268025 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".