MEDICARE: TOMOKO TAKANO MS, RN, CNS

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	364S00000X	Clinical Nurse Specialist	4754	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4754	OTHER	CA	CLINICAL NURSE SPECIALIST

General Provider Information

NPI Number	:	1134697238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMOKO TAKANO MS, RN, CNS

Provider Business Mailing Address
First Line	:	1520 LOS MONTES DR
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-5964
Country	:	US
Telephone Number	:	248-703-4518
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 LOS MONTES DR
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-5964
Country	:	US
Telephone Number	:	248-703-4518
Fax Number	:

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

Provider Enumeration Date	:	11/06/2018
Last Update Date	:	11/06/2018

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