Healthcare Provider Details

I. General information

NPI: 1265218846
Provider Name (Legal Business Name): TESFA DAREBO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TESFATSEIYON DAREBO

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4507 ESPANA WAY
DENVER CO
80249-6651
US

IV. Provider business mailing address

4507 ESPANA WAY
DENVER CO
80249-6651
US

V. Phone/Fax

Practice location:
  • Phone: 720-589-9347
  • Fax:
Mailing address:
  • Phone: 720-589-9347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: