Provider Demographics
NPI:1922863331
Name:TAKAHASHI, KATHLEEN (LVN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:TAKAHASHI
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17044 LURELANE ST
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1520
Mailing Address - Country:US
Mailing Address - Phone:909-697-0607
Mailing Address - Fax:
Practice Address - Street 1:17044 LURELANE ST
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1520
Practice Address - Country:US
Practice Address - Phone:909-697-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA238441164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse