MEDICARE: DR. RONALD TAKEMOTO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	G44903	CA

General Provider Information

NPI Number	:	1104856152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD TAKEMOTO M.D.

Provider Business Mailing Address
First Line	:	1873 TULANE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-3045
Country	:	US
Telephone Number	:	562-233-8966
Fax Number	:	562-492-6830

Provider Business Practice Location Address
First Line	:	1873 TULANE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-3045
Country	:	US
Telephone Number	:	562-233-8966
Fax Number	:	562-492-6830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/07/2021

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