Healthcare Provider Details

I. General information

NPI: 1821901372
Provider Name (Legal Business Name): TESFAHIWET G GEBRESILASIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 PACIFIC AVE STE 600
TACOMA WA
98402-4437
US

IV. Provider business mailing address

2110 GYPSUM DR
RICHMOND TX
77469-4356
US

V. Phone/Fax

Practice location:
  • Phone: 253-844-4327
  • Fax:
Mailing address:
  • Phone: 832-535-4318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number70184263
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: