Healthcare Provider Details

I. General information

NPI: 1295233716
Provider Name (Legal Business Name): BAHAREH MOSHTAGH ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 4TH AVE STE 1000
SEATTLE WA
98161
US

IV. Provider business mailing address

2219 14TH AVE W APT 404
SEATTLE WA
98119-2445
US

V. Phone/Fax

Practice location:
  • Phone: 206-622-9001
  • Fax: 206-622-4311
Mailing address:
  • Phone: 425-318-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: