Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 036118723 | IL |
NPI | 1043415961 |
---|---|
Provider Name | Tara E Seery |
First Address | Costa Mesa, CA 92627-7738 |
Second Address | Costa Mesa, CA 92627-7738 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 26/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036118723 | (05) | IL |