Healthcare Provider Details

I. General information

NPI: 1386576932
Provider Name (Legal Business Name): TIZITA TADESSE TEKLETSADIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 GRAND AVE
OAKLAND CA
94610-3515
US

IV. Provider business mailing address

1919 YGNACIO VALLEY RD APT 52
WALNUT CREEK CA
94598-3292
US

V. Phone/Fax

Practice location:
  • Phone: 510-444-1671
  • Fax: 510-373-2495
Mailing address:
  • Phone: 510-434-4638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: