Provider Demographics
NPI:1295340354
Name:TANAMI, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:TANAMI
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:PO BOX 2446
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-0446
Mailing Address - Country:US
Mailing Address - Phone:516-547-4277
Mailing Address - Fax:
Practice Address - Street 1:6771 WARNER AVE UNIT 2446
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-9461
Practice Address - Country:US
Practice Address - Phone:516-547-4277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2021-07-22
Deactivation Date:2020-10-23
Deactivation Code:
Reactivation Date:2021-07-22
Provider Licenses
StateLicense IDTaxonomies
CA72861225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist