1093306367 NPI number — MAYA TAKANO PA-C

Table of content: MAYA TAKANO PA-C (NPI 1093306367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093306367 NPI number — MAYA TAKANO PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAKANO
Provider First Name:
MAYA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1093306367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7456 SALERNO CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79606-6085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-232-3201
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 S CLAY ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENNIS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75119-5771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-875-5220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  PA14226 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)