Provider Demographics
NPI:1508123217
Name:TAKATORI, NANAE (MD)
Entity Type:Individual
Prefix:
First Name:NANAE
Middle Name:
Last Name:TAKATORI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 HEALTH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2762
Mailing Address - Country:US
Mailing Address - Phone:858-939-6531
Mailing Address - Fax:858-874-2351
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:GRANT S101
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5109
Practice Address - Country:US
Practice Address - Phone:650-723-6661
Practice Address - Fax:650-498-6205
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126593207RG0100X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program