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General NPI Number Information
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NPI Number | 1578225983
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Entity Type | Individual
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Provider Name | TAMRA TAKEMOTO PAC
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Gender | Female
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 1100 9TH AVE
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City | SEATTLE
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State | WA
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Zip | 98101-2756
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Country | US
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Telephone | 206-223-6198
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Fax | 206-341-0951
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Provider Business Mailing Address
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Address Line | PO BOX 741515
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City | LOS ANGELES
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State | CA
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Zip | 90074-1515
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Country | US
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Telephone | 206-223-6198
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Fax | 206-341-0951
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA70058492
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9072
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License Number State | MA
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