Provider Demographics
NPI:1225744071
Name:SERHAL, TASNEEM
Entity Type:Individual
Prefix:
First Name:TASNEEM
Middle Name:
Last Name:SERHAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4484 HEADEN WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-4133
Mailing Address - Country:US
Mailing Address - Phone:714-726-4989
Mailing Address - Fax:
Practice Address - Street 1:4484 HEADEN WAY
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-4133
Practice Address - Country:US
Practice Address - Phone:714-726-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86118286133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered