Provider Demographics
NPI:1881896850
Name:TAKASE-SANCHEZ, MICHELLE MIKI (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MIKI
Last Name:TAKASE-SANCHEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MIKI
Other - Last Name:TAKASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2795 LOMA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1544
Mailing Address - Country:US
Mailing Address - Phone:805-643-8695
Mailing Address - Fax:805-643-2087
Practice Address - Street 1:2949 LOMA VISTA RD
Practice Address - Street 2:OB GYN DEPT
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2981
Practice Address - Country:US
Practice Address - Phone:805-643-8695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92628207V00000X, 2088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyUrogynecology and Reconstructive Pelvic Surgery