Healthcare Provider Details

I. General information

NPI: 1033855739
Provider Name (Legal Business Name): SIEFU T TSEGAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MARKET ST
SAN FRANCISCO CA
94103-1589
US

IV. Provider business mailing address

2900 MARTIN LUTHER KING JR WAY
OAKLAND CA
94609-3518
US

V. Phone/Fax

Practice location:
  • Phone: 510-712-3174
  • Fax: 415-863-7343
Mailing address:
  • Phone: 510-712-3174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN293070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: