Provider Demographics
NPI:1669642385
Name:TAKETANI, TAMARA NICOLE (MD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:NICOLE
Last Name:TAKETANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5333 HOLLISTER AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2341
Mailing Address - Country:US
Mailing Address - Phone:805-569-7876
Mailing Address - Fax:805-569-8398
Practice Address - Street 1:5333 HOLLISTER AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2341
Practice Address - Country:US
Practice Address - Phone:805-569-7876
Practice Address - Fax:805-569-8398
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1010842080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology