Provider Demographics
NPI:1073750253
Name:TAMANAHA, NICKOLAI TOSHIRO
Entity Type:Individual
Prefix:MR
First Name:NICKOLAI
Middle Name:TOSHIRO
Last Name:TAMANAHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 HOWARD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2820
Mailing Address - Country:US
Mailing Address - Phone:415-748-0669
Mailing Address - Fax:415-934-3429
Practice Address - Street 1:1899 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3501
Practice Address - Country:US
Practice Address - Phone:415-748-0669
Practice Address - Fax:415-934-3429
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator