Healthcare Provider Details

I. General information

NPI: 1235602228
Provider Name (Legal Business Name): HIROKI TAKEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 CALLE DE RAFAEL NE
ALBUQUERQUE NM
87122-1037
US

IV. Provider business mailing address

2306 CALLE DE RAFAEL NE
ALBUQUERQUE NM
87122-1037
US

V. Phone/Fax

Practice location:
  • Phone: 505-423-4139
  • Fax:
Mailing address:
  • Phone: 505-423-4139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number979
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: