Healthcare Provider Details

I. General information

NPI: 1245980523
Provider Name (Legal Business Name): MONA SABETRASEKH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 16TH AVE E # CHS545
SEATTLE WA
98112-5211
US

IV. Provider business mailing address

9505 S STEELE ST
TACOMA WA
98444-6858
US

V. Phone/Fax

Practice location:
  • Phone: 206-326-3769
  • Fax:
Mailing address:
  • Phone: 253-597-6800
  • Fax: 253-597-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP61584628
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: