Provider Demographics
NPI:1801418132
Name:TARASSOLI, BAHAREH
Entity Type:Individual
Prefix:DR
First Name:BAHAREH
Middle Name:
Last Name:TARASSOLI
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 1:6922 117TH DR NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8453
Mailing Address - Country:US
Mailing Address - Phone:425-351-2264
Mailing Address - Fax:
Practice Address - Street 1:11656 98TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4216
Practice Address - Country:US
Practice Address - Phone:425-351-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60857453175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath