Provider Demographics
NPI:1548498850
Name:TAKUSHI-GEYROZAGA, LLC
Entity type:Organization
Organization Name:TAKUSHI-GEYROZAGA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:KATSUKO
Authorized Official - Last Name:TAKUSHI-GEYROZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:650-357-1159
Mailing Address - Street 1:1291 E HILLSDALE BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1220
Mailing Address - Country:US
Mailing Address - Phone:650-357-1159
Mailing Address - Fax:650-357-1161
Practice Address - Street 1:1291 E HILLSDALE BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1220
Practice Address - Country:US
Practice Address - Phone:650-357-1159
Practice Address - Fax:650-357-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty