MEDICARE: PHILICIA L TAKESHIMA M.ED., BCBA

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	103K00000X	Behavior Analyst		CA

General Provider Information

NPI Number	:	1932348109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILICIA L TAKESHIMA M.ED., BCBA

Provider Business Mailing Address
First Line	:	170 ARLENE DR
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94595-1754
Country	:	US
Telephone Number	:	925-324-6372
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 MT DIABLO BLVD STE 107
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-3780
Country	:	US
Telephone Number	:	510-665-9700
Fax Number	:	510-665-9400

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

Provider Enumeration Date	:	02/12/2009
Last Update Date	:	12/26/2018

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