Healthcare Provider Details

I. General information

NPI: 1912779638
Provider Name (Legal Business Name): BELAY Z GEBRESENBET
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13551 W REDFIELD RD
SURPRISE AZ
85379-8401
US

IV. Provider business mailing address

13551 W REDFIELD RD
SURPRISE AZ
85379-8401
US

V. Phone/Fax

Practice location:
  • Phone: 602-332-3223
  • Fax:
Mailing address:
  • Phone: 602-332-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: