Provider Demographics
NPI:1033361530
Name:TAKIS, MARIE-JEANNE N/A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE-JEANNE
Middle Name:N/A
Last Name:TAKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 SAN MATEO AVE
Mailing Address - Street 2:N-5
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-4445
Mailing Address - Country:US
Mailing Address - Phone:650-588-5456
Mailing Address - Fax:650-588-5456
Practice Address - Street 1:440 SAN MATEO AVE
Practice Address - Street 2:N-5
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-4445
Practice Address - Country:US
Practice Address - Phone:650-588-5456
Practice Address - Fax:650-588-5456
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42330208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics