Healthcare Provider Details

I. General information

NPI: 1366087603
Provider Name (Legal Business Name): SARETH TES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 NAPA VALLEY CORPORATE DR BLDG B
NAPA CA
94558-6216
US

IV. Provider business mailing address

2101 COURAGE DR
FAIRFIELD CA
94533-6717
US

V. Phone/Fax

Practice location:
  • Phone: 707-227-3900
  • Fax:
Mailing address:
  • Phone: 707-428-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number707994
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: