Provider Demographics
NPI:1376867564
Name:TAIS, SETAREH (ND)
Entity Type:Individual
Prefix:DR
First Name:SETAREH
Middle Name:
Last Name:TAIS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 N FRESNO ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5268
Mailing Address - Country:US
Mailing Address - Phone:209-218-6761
Mailing Address - Fax:209-653-0633
Practice Address - Street 1:6225 N FRESNO ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5268
Practice Address - Country:US
Practice Address - Phone:209-218-6761
Practice Address - Fax:209-653-0633
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60113318175F00000X
CANDF-539175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath