Provider Demographics
NPI:1265998405
Name:TAKIAR, RICHARD
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:TAKIAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 KING AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-2807
Mailing Address - Country:US
Mailing Address - Phone:530-713-6640
Mailing Address - Fax:
Practice Address - Street 1:568 KING AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-2807
Practice Address - Country:US
Practice Address - Phone:530-713-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA97873718EMedicaid