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General NPI Number Information
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NPI Number | 1053095901
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Entity Type | Individual
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Provider Name | NATHANIEL SHIGERU MACHADO TANIGUCHI OTR/L
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Gender | Male
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 325 S BOYLE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90033-3812
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Country | US
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Telephone | 213-986-9755
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Fax |
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Provider Business Mailing Address
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Address Line | 15407 GOLDEN LANTERN LN
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City | LA MIRADA
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State | CA
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Zip | 90638-1510
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 25070
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License Number State | CA
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