Healthcare Provider Details

I. General information

NPI: 1609526854
Provider Name (Legal Business Name): TEWODROS TEKLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 HERNDON AVE
CLOVIS CA
93611-6813
US

IV. Provider business mailing address

2740 HERNDON AVE
CLOVIS CA
93611-6813
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-2608
  • Fax:
Mailing address:
  • Phone: 559-299-2608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA204534
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: