Healthcare Provider Details

I. General information

NPI: 1902743289
Provider Name (Legal Business Name): YODIT AKALE GEBREWELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6131 N 27TH AVE APT 2090
PHOENIX AZ
85017-1759
US

IV. Provider business mailing address

6131 N 27TH AVE APT 2090
PHOENIX AZ
85017-1759
US

V. Phone/Fax

Practice location:
  • Phone: 712-259-1684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number25039786
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: