Healthcare Provider Details

I. General information

NPI: 1104596923
Provider Name (Legal Business Name): HANA TESFAYE FIKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9943 JEREMY ST
SANTEE CA
92071-1948
US

IV. Provider business mailing address

2212 GILL VILLAGE WAY
SAN DIEGO CA
92108-5548
US

V. Phone/Fax

Practice location:
  • Phone: 619-227-0383
  • Fax:
Mailing address:
  • Phone: 619-865-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: