Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 95001528 | CA |
NPI | 1013311471 |
---|---|
Provider Name | Saba Tesfay |
First Address | Fullerton, CA 92833-1725 |
Second Address | Fullerton, CA 92833-1725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2014 |
Last Update Date | 14/10/2014 |