Provider Demographics
NPI:1912023656
Name:TANIGUCHI, RANDY S (NNP)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:S
Last Name:TANIGUCHI
Suffix:
Gender:M
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712A PALI HWY
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1428
Mailing Address - Country:US
Mailing Address - Phone:808-595-5283
Mailing Address - Fax:
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-983-8671
Practice Address - Fax:808-983-6382
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI438363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care