Provider Demographics
NPI:1255838454
Name:TAGUCHI, MEARI
Entity Type:Individual
Prefix:
First Name:MEARI
Middle Name:
Last Name:TAGUCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 MILL ST # M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-3900
Practice Address - Street 1:1500 E 2ND ST STE 300
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1198
Practice Address - Country:US
Practice Address - Phone:775-982-5262
Practice Address - Fax:775-982-3900
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43015064052084N0400X
NV240382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV24038OtherNEVADA MD
NV15907939OtherCAQH NUMBER