Provider Demographics
NPI:1205847555
Name:YOSHITAKE, TERI L (MD)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:L
Last Name:YOSHITAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:L
Other - Last Name:ONOUYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1601 MONTE VISTA AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-6600
Mailing Address - Country:US
Mailing Address - Phone:909-865-9977
Mailing Address - Fax:909-694-2119
Practice Address - Street 1:1601 MONTE VISTA AVE STE 190
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-6600
Practice Address - Country:US
Practice Address - Phone:909-865-9977
Practice Address - Fax:909-469-2119
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-13404207P00000X
CAA80605207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI569014Medicaid
CAP01138568OtherMEDICARE RR- NO CAL
HI0000254037OtherHMSA
CAFK362ZOtherPTAN- SO CAL
CAFK362YOtherPTAN- NO CAL
HI0000254037OtherHMSA