Healthcare Provider Details

I. General information

NPI: 1861519233
Provider Name (Legal Business Name): CAROL S. TANIGUCHI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WOODSIDE AVE SPECIAL PROGRAM FOR YOUTH
SAN FRANCISCO CA
94127-1221
US

IV. Provider business mailing address

375 WOODSIDE AVE SPECIAL PROGRAM FOR YOUTH
SAN FRANCISCO CA
94127-1221
US

V. Phone/Fax

Practice location:
  • Phone: 415-753-7808
  • Fax: 415-753-7822
Mailing address:
  • Phone: 415-753-7808
  • Fax: 415-753-7822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN583581
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF14321
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberCNS1906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: