Healthcare Provider Details

I. General information

NPI: 1235992421
Provider Name (Legal Business Name): MESKEREM N GEBREMEDHIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 04/06/2025
Certification Date: 04/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17102 DE GROOT PL
CERRITOS CA
90703-1185
US

IV. Provider business mailing address

17102 DE GROOT PL
CERRITOS CA
90703-1185
US

V. Phone/Fax

Practice location:
  • Phone: 323-681-1460
  • Fax:
Mailing address:
  • Phone: 323-681-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: