Provider Demographics
NPI:1194348318
Name:SIEWERT, THAIS (PMHNP)
Entity type:Individual
Prefix:DR
First Name:THAIS
Middle Name:
Last Name:SIEWERT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:DR
Other - First Name:THAIS
Other - Middle Name:NAN
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17595 HARVARD AVE
Mailing Address - Street 2:STE C, #169
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-8574
Mailing Address - Country:US
Mailing Address - Phone:949-424-5444
Mailing Address - Fax:
Practice Address - Street 1:888 PROSPECT ST STE 200
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4261
Practice Address - Country:US
Practice Address - Phone:415-849-2466
Practice Address - Fax:415-376-4529
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014585363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty