Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | RDHAP 615 | CA |
NPI | 1043664824 |
---|---|
Provider Name | Fekerte Bezuayehu |
First Address | Oakland, CA 94619-2216 |
Second Address | Richmond, CA 94801-3105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2016 |
Last Update Date | 09/04/2017 |