Healthcare Provider Details

I. General information

NPI: 1104784792
Provider Name (Legal Business Name): DR. MESFIN GEBREEGZIABHER DESTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 02/14/2026
Certification Date: 02/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 PACIFIC AVE STE 600
TACOMA WA
98402-4437
US

IV. Provider business mailing address

917 PACIFIC AVE STE 600
TACOMA WA
98402-4437
US

V. Phone/Fax

Practice location:
  • Phone: 253-844-4327
  • Fax:
Mailing address:
  • Phone: 253-844-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMDCE.ML.70087335
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: