Provider Demographics
NPI:1235476672
Name:SERETI, GARYFALIA (MED)
Entity Type:Individual
Prefix:
First Name:GARYFALIA
Middle Name:
Last Name:SERETI
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 NORTHUP WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1480
Mailing Address - Country:US
Mailing Address - Phone:425-822-6442
Mailing Address - Fax:425-828-3101
Practice Address - Street 1:3003 NORTHUP WAY STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1480
Practice Address - Country:US
Practice Address - Phone:425-822-6442
Practice Address - Fax:425-828-3101
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60318230251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health