Healthcare Provider Details

I. General information

NPI: 1407483647
Provider Name (Legal Business Name): SHIORI ANNE TAKASHIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MARIN ST STE 290
THOUSAND OAKS CA
91360-4112
US

IV. Provider business mailing address

5375 COIT RD STE 100
FRISCO TX
75035-4911
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-6979
  • Fax:
Mailing address:
  • Phone: 972-712-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: