Healthcare Provider Details

I. General information

NPI: 1922943059
Provider Name (Legal Business Name): MAHLET TESEMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 NW LEARY WAY STE 400
SEATTLE WA
98107-5138
US

IV. Provider business mailing address

100 N PACIFIC COAST HWY STE 1400
EL SEGUNDO CA
90245-5602
US

V. Phone/Fax

Practice location:
  • Phone: 206-504-3815
  • Fax: 855-568-2494
Mailing address:
  • Phone: 310-856-0800
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: