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General NPI Number Information
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NPI Number | 1346021508
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Entity Type | Individual
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Provider Name | MASRESHAW A TEBEJE
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Gender | Male
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 3517 MARCONI AVE STE 107C1
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City | SACRAMENTO
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State | CA
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Zip | 95821-5328
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Country | US
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Telephone | 916-855-9054
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2331
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City | CARMICHAEL
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State | CA
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Zip | 95609-2331
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Country | US
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Telephone | 916-885-9054
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 9FTF330
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License Number State | CA
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