MEDICARE: MS. TIRHEAS TUKU KIFLEZGHIE

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	598079	CA
2	363LA2100X	Acute Care Nurse Practitioner	17523	CA

General Provider Information

NPI Number	:	1306008842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIRHEAS TUKU KIFLEZGHIE

Provider Business Mailing Address
First Line	:	1983 MARENGO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1370
Country	:	US
Telephone Number	:	323-409-6715
Fax Number	:

Provider Business Practice Location Address
First Line	:	1983 MARENGO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1370
Country	:	US
Telephone Number	:	323-409-6715
Fax Number	:

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

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	10/20/2016

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