Provider Demographics
NPI:1376841601
Name:TAKENAGA, MAYRA
Entity Type:Individual
Prefix:MS
First Name:MAYRA
Middle Name:
Last Name:TAKENAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 N POST OAK RD
Mailing Address - Street 2:#6107
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-7274
Mailing Address - Country:US
Mailing Address - Phone:713-213-2559
Mailing Address - Fax:
Practice Address - Street 1:19073 I-45 S
Practice Address - Street 2:SUITE 145
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8743
Practice Address - Country:US
Practice Address - Phone:936-273-4437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10952235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist