Provider Demographics
NPI:1538795018
Name:TAKAHASHI, SAKURA (MPH, RD)
Entity type:Individual
Prefix:
First Name:SAKURA
Middle Name:
Last Name:TAKAHASHI
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 MARSHALL ST APT 208
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2165
Mailing Address - Country:US
Mailing Address - Phone:650-814-4689
Mailing Address - Fax:
Practice Address - Street 1:750 WELCH RD STE 214
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1509
Practice Address - Country:US
Practice Address - Phone:650-814-4689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric