Provider Demographics
NPI:1992968648
Name:TAKAYAMA, CHRISTIAN MARIO (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:MARIO
Last Name:TAKAYAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43322 GINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-4569
Mailing Address - Country:US
Mailing Address - Phone:661-874-4050
Mailing Address - Fax:
Practice Address - Street 1:43322 GINGHAM AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4569
Practice Address - Country:US
Practice Address - Phone:661-874-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine