Healthcare Provider Details

I. General information

NPI: 1043415961
Provider Name (Legal Business Name): TARA E SEERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16105 SAND CANYON AVE STE 230
IRVINE CA
92618-3780
US

IV. Provider business mailing address

16105 SAND CANYON AVE STE 230
IRVINE CA
92618-3780
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-5347
  • Fax: 949-557-0221
Mailing address:
  • Phone: 949-764-5347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036118723
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number036118723
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: