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General NPI Number Information
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NPI Number | 1013604768
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Entity Type | Individual
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Provider Name | TEMESGEN WEDAJO
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Gender | Male
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Dates
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Enumeration Date | 04/21/2023
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 10318 W HESS ST
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City | TOLLESON
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State | AZ
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Zip | 85353-1242
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Country | US
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Telephone | 623-455-0561
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Fax |
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Provider Business Mailing Address
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Address Line | 10318 W HESS ST
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City | TOLLESON
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State | AZ
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Zip | 85353-1242
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Country | US
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Telephone | 623-455-0561
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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