MEDICARE: TSEGAW AYELE DEBARCHO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver		CA

General Provider Information

NPI Number	:	1457284242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TSEGAW AYELE DEBARCHO

Provider Business Mailing Address
First Line	:	2501 PICO BLVD APT 104
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-1833
Country	:	US
Telephone Number	:	323-247-0566
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 PICO BLVD APT 104
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-1833
Country	:	US
Telephone Number	:	323-247-0566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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Directions to “ TSEGAW AYELE DEBARCHO ” Practice Location

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