Provider Demographics
NPI:1134510761
Name:WILSON, SEITHEACH (NMD)
Entity Type:Individual
Prefix:DR
First Name:SEITHEACH
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE BONIFACIO HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:TAGUIG
Mailing Address - State:METRO MANILA
Mailing Address - Zip Code:01630
Mailing Address - Country:PH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9620 S LAS VEGAS BLVD
Practice Address - Street 2:SUITE E4 #1017
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-6508
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ22131202003186146L00000X
NV175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopath
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty