Provider Demographics
NPI:1053565036
Name:TAKETA, ASHLEY SHIZUKO (RD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SHIZUKO
Last Name:TAKETA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 RED RANCH CV
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4914
Mailing Address - Country:US
Mailing Address - Phone:512-944-2069
Mailing Address - Fax:
Practice Address - Street 1:1303 RED RANCH CV
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4914
Practice Address - Country:US
Practice Address - Phone:512-944-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80984133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered