Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | NP95006949 | CA |
Y | 363L00000X | Nurse Practitioner | NP95006949 | CA |
NPI | 1043718927 |
---|---|
Provider Name | Berhane Mebratu |
First Address | Fresno, CA 93720-0155 |
Second Address | Fresno, CA 93720-0155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2018 |
Last Update Date | 08/03/2018 |