Provider Demographics
NPI:1437745767
Name:ELIX, TAKARA AKEDA
Entity Type:Individual
Prefix:
First Name:TAKARA
Middle Name:AKEDA
Last Name:ELIX
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 1:5506 S WALKER AVE APT 117
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-7920
Mailing Address - Country:US
Mailing Address - Phone:405-458-2024
Mailing Address - Fax:
Practice Address - Street 1:5506 S WALKER AVE APT 117
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-7920
Practice Address - Country:US
Practice Address - Phone:405-977-2884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist