Healthcare Provider Details

I. General information

NPI: 1376867564
Provider Name (Legal Business Name): SETAREH TAIS N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 N FRESNO ST SUITE 103
FRESNO CA
93710-5268
US

IV. Provider business mailing address

6225 N FRESNO ST SUITE 103
FRESNO CA
93710-5268
US

V. Phone/Fax

Practice location:
  • Phone: 209-218-6761
  • Fax: 209-653-0633
Mailing address:
  • Phone: 209-218-6761
  • Fax: 209-653-0633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60113318
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNDF-539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: