MEDICARE: AKIHO TANAKA, PHD, LLC

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	103TC0700X	Clinical Psychologist	PY8836	FL

General Provider Information

NPI Number	:	1811322811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AKIHO TANAKA, PHD, LLC

Provider Business Mailing Address
First Line	:	1011 VIRGINIA DR STE 102
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-2526
Country	:	US
Telephone Number	:	407-335-8211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 VIRGINIA DR STE 102
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-2526
Country	:	US
Telephone Number	:	407-335-8211
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. AKIHO TANAKA
Credential	:	PH.D.
Telephone Number	:	407-335-8211

Provider Enumeration Date	:	09/09/2013
Last Update Date	:	11/30/2021

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