Provider Demographics
NPI:1720290752
Name:MITSUHASHI, TAKAKO (MD,PHD)
Entity Type:Individual
Prefix:
First Name:TAKAKO
Middle Name:
Last Name:MITSUHASHI
Suffix:
Gender:F
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1601
Mailing Address - Country:US
Mailing Address - Phone:949-265-1782
Mailing Address - Fax:949-754-9330
Practice Address - Street 1:2601 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1601
Practice Address - Country:US
Practice Address - Phone:949-265-1782
Practice Address - Fax:949-754-9330
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69535207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology