Healthcare Provider Details

I. General information

NPI: 1396339727
Provider Name (Legal Business Name): ABERA YOSEF TESFAYE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 CONDOR DR UNIT 53
CHULA VISTA CA
91915-2904
US

IV. Provider business mailing address

2175 CONDOR DR UNIT 53
CHULA VISTA CA
91915-2904
US

V. Phone/Fax

Practice location:
  • Phone: 805-284-6497
  • Fax: 619-415-8119
Mailing address:
  • Phone: 805-284-6497
  • Fax: 619-415-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95016770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: