Provider Demographics
NPI:1134697238
Name:TAKANO, TOMOKO (MS, RN, CNS)
Entity Type:Individual
Prefix:
First Name:TOMOKO
Middle Name:
Last Name:TAKANO
Suffix:
Gender:F
Credentials:MS, RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 LOS MONTES DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-5964
Mailing Address - Country:US
Mailing Address - Phone:248-703-4518
Mailing Address - Fax:
Practice Address - Street 1:1520 LOS MONTES DR
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-5964
Practice Address - Country:US
Practice Address - Phone:248-703-4518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4754364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4754OtherCLINICAL NURSE SPECIALIST