Healthcare Provider Details

I. General information

NPI: 1861317588
Provider Name (Legal Business Name): RICHARD TAKESHI TAKASUGI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 PIONEER CT
SAN MATEO CA
94403-1781
US

IV. Provider business mailing address

2015 PIONEER CT
SAN MATEO CA
94403-1781
US

V. Phone/Fax

Practice location:
  • Phone: 408-483-1593
  • Fax:
Mailing address:
  • Phone: 408-483-1593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: