Healthcare Provider Details

I. General information

NPI: 1063755882
Provider Name (Legal Business Name): RACHELLE NICOLAI TAKENO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

333 N 300 W
SALT LAKE CITY UT
84103-1215
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-8571
  • Fax: 916-734-7950
Mailing address:
  • Phone: 801-463-7415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9759703-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: