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Individual

KEITAROH TAKEDA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
4801 ALBERTA AVE, EL PASO, TX 79905-2707
(915) 215-4625
Mailing address
4801 ALBERTA AVE, EL PASO, TX 79905-2707

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M-2357
GU
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
07/01/2016
Last updated
01/02/2023
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