Provider Demographics
NPI:1497827562
Name:TAKEDA, PATRICIA A
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:TAKEDA
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 1:1010 HURLEY WAY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3216
Mailing Address - Country:US
Mailing Address - Phone:916-564-3040
Mailing Address - Fax:916-564-3065
Practice Address - Street 1:3941 J STREET
Practice Address - Street 2:SUITE 260
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3633
Practice Address - Country:US
Practice Address - Phone:916-736-2323
Practice Address - Fax:916-736-0620
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37296207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ47675ZOtherBLUE SHIELD
CAGR0068232Medicaid
CA060035969OtherRAILROAD MEDICARE
CAZZZ47676ZOtherBLUE SHIELD
CAGR0068231Medicaid
CAZZZ62306ZOtherBLUE SHIELD
CAGR0068235Medicaid
CAGR0068233Medicaid
CAGR006823BMedicaid
CA00G372960Medicaid
CAGR0068230Medicaid
CAZZZ47673ZOtherBLUE SHIELD
CAZZZ47676ZOtherBLUE SHIELD
CAGR0068233Medicaid
CAGR0068230Medicaid
CA00G372960Medicare ID - Type Unspecified
CAZZZ00966ZMedicare PIN
CAZZZ47673ZOtherBLUE SHIELD
CA060035969OtherRAILROAD MEDICARE
CAGR006823BMedicaid