Provider Demographics
NPI:1568162352
Name:TAKIJIRI, AKANE
Entity Type:Individual
Prefix:
First Name:AKANE
Middle Name:
Last Name:TAKIJIRI
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 1:2932 FAIRMOUNT AVE.
Mailing Address - Street 2:3
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2807
Mailing Address - Country:US
Mailing Address - Phone:818-447-9393
Mailing Address - Fax:
Practice Address - Street 1:12156 1/2 RIVERSIDE DR.
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3829
Practice Address - Country:US
Practice Address - Phone:818-447-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137976106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist