Provider Demographics
NPI:1639802366
Name:TANIGUCHI, NICHOLAS CHARLES
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CHARLES
Last Name:TANIGUCHI
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 1:16100 SPACE CENTER BLVD APT 715
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-6232
Mailing Address - Country:US
Mailing Address - Phone:715-591-2563
Mailing Address - Fax:
Practice Address - Street 1:16100 SPACE CENTER BLVD APT 715
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-6232
Practice Address - Country:US
Practice Address - Phone:715-591-2563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician