Healthcare Provider Details

I. General information

NPI: 1851295380
Provider Name (Legal Business Name): RUI TANIMURA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 30TH ST APT 134
BOULDER CO
80301-3004
US

IV. Provider business mailing address

1955 30TH ST APT 134
BOULDER CO
80301-3004
US

V. Phone/Fax

Practice location:
  • Phone: 508-404-4918
  • Fax:
Mailing address:
  • Phone: 508-404-4918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: RUI TANIMURA
Title or Position: OWNER/REGISTERED DIETITIAN
Credential: RDN
Phone: 508-404-4918