Healthcare Provider Details

I. General information

NPI: 1396618393
Provider Name (Legal Business Name): KANOKO TANIGUCHI TANAKA NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 CAMINO DE LOS MARES STE 101
SAN CLEMENTE CA
92673-2829
US

IV. Provider business mailing address

629 CAMINO DE LOS MARES STE 101
SAN CLEMENTE CA
92673-2829
US

V. Phone/Fax

Practice location:
  • Phone: 949-866-1356
  • Fax: 949-850-3500
Mailing address:
  • Phone: 949-866-1356
  • Fax: 949-850-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: