=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558633743
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL TANIGAWA MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2012
-----------------------------------------------------
Last Update Date | 02/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5995 PLAZA DR MAILSTOP: CA112-0533
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90630
-----------------------------------------------------
Country | UM
-----------------------------------------------------
Telephone | 714-226-3766
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5598 NAPLES CANAL
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90803-4018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-226-3766
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A35106
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------