Healthcare Provider Details

I. General information

NPI: 1881060945
Provider Name (Legal Business Name): TAKAO TAMESA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

IV. Provider business mailing address

221 EDISTO CT
CHAPEL HILL NC
27514-1668
US

V. Phone/Fax

Practice location:
  • Phone: 409-747-8736
  • Fax:
Mailing address:
  • Phone: 919-590-2556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number0000000000000
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: