Provider Demographics
NPI:1497579114
Name:TITA TAKU, ZEPHANIAH
Entity type:Individual
Prefix:
First Name:ZEPHANIAH
Middle Name:
Last Name:TITA TAKU
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 1:7005 E RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4913
Mailing Address - Country:US
Mailing Address - Phone:240-877-8478
Mailing Address - Fax:
Practice Address - Street 1:7005 E RIDGE DR
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4913
Practice Address - Country:US
Practice Address - Phone:240-729-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator