Individual ProviderAlyssa TakedaStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address383 E Shepherd Ave, Fresno, CA 93720-1662(559) 824-5350PECOS EnrollmentBased on the most recent information from CMS, provider Alyssa Takeda does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1841619400Provider TypeIndividualFull NameTakeda, AlyssaCredentialDDSGenderFemaleSole ProprietorNoEnumeration Date4/10/2014Last Updated4/10/2014Contact InformationPractice LocationPractice Address383 E Shepherd Ave, Fresno, CA 93720-1662Phone(559) 824-5350FaxUnlisted FaxMailing LocationMailing Address383 E Shepherd Ave, Fresno, CA 93720-1662Phone(559) 824-5350FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer