Healthcare Provider Details

I. General information

NPI: 1841117124
Provider Name (Legal Business Name): ZENEBESH GHEBRESELLASIE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10366 MILLER AVE
CUPERTINO CA
95014-3426
US

IV. Provider business mailing address

18651 CRABTREE AVE
CUPERTINO CA
95014-3864
US

V. Phone/Fax

Practice location:
  • Phone: 408-703-3336
  • Fax:
Mailing address:
  • Phone: 408-218-2609
  • Fax: 408-564-5905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number435202979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: