Healthcare Provider Details

I. General information

NPI: 1003439746
Provider Name (Legal Business Name): HOWARD TAKIFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 LA CANADA ST
LA JOLLA CA
92037-6724
US

IV. Provider business mailing address

PO BOX 2095
LA JOLLA CA
92038-2095
US

V. Phone/Fax

Practice location:
  • Phone: 949-981-4018
  • Fax:
Mailing address:
  • Phone: 949-981-4018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG51566
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberG51566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: