Healthcare Provider Details

I. General information

NPI: 1548198443
Provider Name (Legal Business Name): DR. MEKDES MOLLA WOLLEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE # MS 50
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

800 S ABEL ST UNIT 205
MILPITAS CA
95035-8694
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-1566
  • Fax:
Mailing address:
  • Phone: 408-480-4445
  • 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: