Provider Demographics
NPI:1861519233
Name:TANIGUCHI, CAROL S (NP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:S
Last Name:TANIGUCHI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 WOODSIDE AVE
Mailing Address - Street 2:SPECIAL PROGRAM FOR YOUTH
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1221
Mailing Address - Country:US
Mailing Address - Phone:415-753-7808
Mailing Address - Fax:415-753-7822
Practice Address - Street 1:375 WOODSIDE AVE
Practice Address - Street 2:SPECIAL PROGRAM FOR YOUTH
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1221
Practice Address - Country:US
Practice Address - Phone:415-753-7808
Practice Address - Fax:415-753-7822
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN583581163WP2201X
CANPF14321363LF0000X
CACNS1906364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
096115OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
096115OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER