Healthcare Provider Details

I. General information

NPI: 1144546797
Provider Name (Legal Business Name): TENAGNEWORK MEKBEB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TENAGNE MEKBEB M.D.

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 01/18/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 ARROYO CIR
GILROY CA
95020-7303
US

IV. Provider business mailing address

1800 HARRISON ST FLOOR 7
OAKLAND CA
94612-3466
US

V. Phone/Fax

Practice location:
  • Phone: 408-848-4600
  • Fax:
Mailing address:
  • Phone: 510-625-6262
  • Fax: 510-625-6226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG74751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: