Provider Demographics
NPI:1164860458
Name:TAKHER, ELLEN S (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:S
Last Name:TAKHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:S
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3435 E THOUSAND OAKS BLVD #3462
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91359
Mailing Address - Country:US
Mailing Address - Phone:805-242-5151
Mailing Address - Fax:
Practice Address - Street 1:1601 CUMMINS DR STE D
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-6411
Practice Address - Country:US
Practice Address - Phone:510-900-3125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1676812084N0400X, 2084P0800X
NV164282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100086468Medicaid