Healthcare Provider Details

I. General information

NPI: 1326392697
Provider Name (Legal Business Name): NANAO TAKAKI N.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9887 W BELL RD
SUN CITY AZ
85351-1344
US

IV. Provider business mailing address

9887 W BELL RD
SUN CITY AZ
85351-1344
US

V. Phone/Fax

Practice location:
  • Phone: 623-977-0077
  • Fax:
Mailing address:
  • Phone: 623-977-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number12-1317
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12-1317
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number12-1317
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number12-1317
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: