Individual
FERN S. TAKEMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6555 COYLE AVE, CARMICHAEL, CA 95608-0302
(916) 733-3333
Mailing address
3400 DATA DR, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G71709
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000810342982
PHCS
CA
05
—
00G717090
—
CA
01
—
016914
HEALTH NET
CA
01
—
1062717
FIRST HEALTH
CA
01
—
1089896
GREAT WEST
CA
01
—
1268025
UNITED HEALTHCARE
CA
01
—
18634
INTERPLAN
CA
01
—
3822049
CIGNA
CA
01
—
4509750
AETNA
CA
01
—
90026157
PACIFICARE
CA
01
—
G71709
BLUE CROSS
CA
01
—
MCMG126500
WESTERN HEALTH ADVANTAGE
CA
Enumeration date
08/31/2006
Last updated
02/13/2012
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