Provider Demographics
NPI:1104459676
Name:TANIGUCHI, AIMY GRACE (MD)
Entity type:Individual
Prefix:
First Name:AIMY
Middle Name:GRACE
Last Name:TANIGUCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SIERRA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3647
Mailing Address - Country:US
Mailing Address - Phone:415-454-7388
Mailing Address - Fax:
Practice Address - Street 1:6 SIERRA CIR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3647
Practice Address - Country:US
Practice Address - Phone:415-454-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22851208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics