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General NPI Number Information
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NPI Number | 1831989631
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Entity Type | Individual
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Provider Name | TADESSE WORKU
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Gender | Male
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 1100 W TOWN AND COUNTRY RD STE 1600
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City | ORANGE
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State | CA
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Zip | 92868-4698
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Country | US
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Telephone | 844-310-2247
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Fax |
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Provider Business Mailing Address
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Address Line | 3501 S BASCOM AVE APT 1
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City | CAMPBELL
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State | CA
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Zip | 95008-7051
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Country | US
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Telephone | 571-723-1401
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP95029959
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95029959
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License Number State | CA
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