Provider Demographics
NPI:1790825032
Name:TAEKMAN, HOWARD PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:PHILLIP
Last Name:TAEKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SAN ANDREAS RD
Mailing Address - Street 2:
Mailing Address - City:LA SELVA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:95076-1744
Mailing Address - Country:US
Mailing Address - Phone:831-724-3003
Mailing Address - Fax:925-947-3220
Practice Address - Street 1:1400 SAN ANDREAS RD
Practice Address - Street 2:
Practice Address - City:LA SELVA BEACH
Practice Address - State:CA
Practice Address - Zip Code:95076-1744
Practice Address - Country:US
Practice Address - Phone:831-724-3003
Practice Address - Fax:925-947-3220
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23214208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41882Medicare UPIN