Healthcare Provider Details

I. General information

NPI: 1366190803
Provider Name (Legal Business Name): AIDA TESFAYE-KEDJELA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 E VALLEY PKWY STE 100
ESCONDIDO CA
92025-3300
US

IV. Provider business mailing address

PO BOX 34120
RENO NV
89533-4120
US

V. Phone/Fax

Practice location:
  • Phone: 877-747-5050
  • Fax:
Mailing address:
  • Phone: 775-747-5050
  • Fax: 775-747-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: AIDA TESFAYE-KEDJELA
Title or Position: OWNER
Credential: MD
Phone: 775-747-5050