Provider Demographics
NPI:1972964096
Name:DR. YASAMAN TASALLOTI, PLLC
Entity Type:Organization
Organization Name:DR. YASAMAN TASALLOTI, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YASAMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TASALLOTI
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:480-779-8854
Mailing Address - Street 1:2134 E BROADWAY RD
Mailing Address - Street 2:UNIT 3043
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1773
Mailing Address - Country:US
Mailing Address - Phone:480-779-8854
Mailing Address - Fax:
Practice Address - Street 1:11000 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 230
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6130
Practice Address - Country:US
Practice Address - Phone:480-779-8854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16-1534175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty