Healthcare Provider Details

I. General information

NPI: 1487787230
Provider Name (Legal Business Name): TIZEBT TAYE ALEMAYEHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N ALAMEDA ST STE 390
LOS ANGELES CA
90012-1804
US

IV. Provider business mailing address

1000 N ALAMEDA ST
LOS ANGELES CA
90012-1804
US

V. Phone/Fax

Practice location:
  • Phone: 138-043-1392
  • Fax:
Mailing address:
  • Phone: 626-577-2261
  • Fax: 626-577-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101980
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number101980
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: