Provider Demographics
NPI:1932133089
Name:S CURTIS TAKAGISHI PHD PA
Entity Type:Organization
Organization Name:S CURTIS TAKAGISHI PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:TAKAGISHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-690-8506
Mailing Address - Street 1:10411 LIGHTNER BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1815
Mailing Address - Country:US
Mailing Address - Phone:813-690-8506
Mailing Address - Fax:
Practice Address - Street 1:13331 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1161
Practice Address - Country:US
Practice Address - Phone:813-690-8506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6420103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AF879OtherMEDICARE