Healthcare Provider Details

I. General information

NPI: 1114830486
Provider Name (Legal Business Name): AMY TAKAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 5TH ST
SAN FRANCISCO CA
94103-2919
US

IV. Provider business mailing address

13609 BODIE CT
SAN DIEGO CA
92129-2154
US

V. Phone/Fax

Practice location:
  • Phone: 415-929-6400
  • Fax:
Mailing address:
  • Phone: 858-312-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: