MEDICARE: SHEWIT TESFAI RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	4271577	CA
2	251K00000X	Public Health or Welfare Agency		CA
3	163W00000X	Registered Nurse	RN95158175	CA

General Provider Information

NPI Number	:	1033067418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEWIT TESFAI RN

Provider Business Mailing Address
First Line	:	5247 KNOWLTON ST APT C
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-2028
Country	:	US
Telephone Number	:	714-718-7752
Fax Number	:

Provider Business Practice Location Address
First Line	:	5247 KNOWLTON ST APT C
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-2028
Country	:	US
Telephone Number	:	714-718-7752
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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