MEDICARE: MELAKU DAMTE DEMSSIE

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	347E00000X	Transportation Broker	38504Z1	CA

General Provider Information

NPI Number	:	1881377935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELAKU DAMTE DEMSSIE

Provider Business Mailing Address
First Line	:	4985 MARKET ST APT 315
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-4730
Country	:	US
Telephone Number	:	619-252-5846
Fax Number	:

Provider Business Practice Location Address
First Line	:	4985 MARKET ST APT 315
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-4730
Country	:	US
Telephone Number	:	619-252-5846
Fax Number	:

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

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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Directions to “ MELAKU DAMTE DEMSSIE ” Practice Location

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