Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 016.005465 | IL |
Y | 213ES0103X | Foot & Ankle Surgery | E5244 | CA |
NPI | 1043506140 |
---|---|
Provider Name | Dr. Ameha Teklu Joba |
First Address | Rohnert Park, CA 94928-2932 |
Second Address | Rohnert Park, CA 94928-2932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2011 |
Last Update Date | 20/02/2017 |