Provider Demographics
NPI:1053461145
Name:SECAIRA, ROBERTO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ANTONIO
Last Name:SECAIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 S YAKIMA AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5305
Mailing Address - Country:US
Mailing Address - Phone:253-627-1244
Mailing Address - Fax:253-627-1244
Practice Address - Street 1:1802 YAKIMA AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4499
Practice Address - Country:US
Practice Address - Phone:253-627-1244
Practice Address - Fax:253-627-6576
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039344174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0162477OtherDEPARTMENT OF L&I
WA1802SEOtherREGENCE
WA1800SEOtherREGENCE
WA8279440Medicaid
WA1708SEOtherREGENCE
WA4767SEOtherREGENCE
WA060068022OtherRAILROAD MEDICARE
WA1300SEOtherREGENCE
WA1802SEOtherREGENCE
WAAB29611Medicare ID - Type UnspecifiedMEDICARE