Healthcare Provider Details

I. General information

NPI: 1780467217
Provider Name (Legal Business Name): SAYAKA TAGUCHI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 HOSPITAL DR
MOUNTAIN VIEW CA
94040-4119
US

IV. Provider business mailing address

2495 HOSPITAL DR STE 460
MOUNTAIN VIEW CA
94040-4172
US

V. Phone/Fax

Practice location:
  • Phone: 650-962-4370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: