Healthcare Provider Details

I. General information

NPI: 1942610464
Provider Name (Legal Business Name): YAROON GEBRESILASSIE KOCHITO FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ASCHALEW KOCHITO GEBRESILASSIE RN

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 MOWRY AVE STE ABDFN
FREMONT CA
94538-1738
US

IV. Provider business mailing address

1999 MOWRY AVE STE ABDFN
FREMONT CA
94538-1738
US

V. Phone/Fax

Practice location:
  • Phone: 510-770-8040
  • Fax:
Mailing address:
  • Phone: 510-770-8040
  • Fax: 916-515-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number791125
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: