Healthcare Provider Details

I. General information

NPI: 1578844668
Provider Name (Legal Business Name): MAKDA TSEHAIE GEBREZGHI ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MAKDA TSEHAIE GEBREZEHI

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 MISSION ST
SAN FRANCISCO CA
94103-2911
US

IV. Provider business mailing address

982 MISSION ST
SAN FRANCISCO CA
94103-2911
US

V. Phone/Fax

Practice location:
  • Phone: 415-271-5124
  • Fax: 415-597-8004
Mailing address:
  • Phone: 415-271-5124
  • Fax: 415-597-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number32377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: