Provider Demographics
NPI:1356733463
Name:SIDERAS, SELENA MARTIN (DO)
Entity type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:MARTIN
Last Name:SIDERAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:MARTIN
Other - Last Name:CORBETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6163 NE RADFORD DR
Mailing Address - Street 2:APT 1421
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7981
Mailing Address - Country:US
Mailing Address - Phone:503-329-0240
Mailing Address - Fax:
Practice Address - Street 1:200 MULLINS DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-3983
Practice Address - Country:US
Practice Address - Phone:541-259-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program