Healthcare Provider Details

I. General information

NPI: 1922039858
Provider Name (Legal Business Name): FREW H GEBREAB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9985 SIERRA AVE PULMONARY DEPARTMENT
FONTANA CA
92335-6720
US

IV. Provider business mailing address

9985 SIERRA AVE PULMONARY DEPARTMENT
FONTANA CA
92335-6720
US

V. Phone/Fax

Practice location:
  • Phone: 909-427-5000
  • Fax:
Mailing address:
  • Phone: 909-427-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME95475
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: