Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | R1212 | TX |
NPI | 1053699694 |
---|---|
Provider Name | Yordanos Azene Habtegebriel |
First Address | Dallas, TX 75240-1374 |
Second Address | Arlington, TX 76015-2908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2011 |
Last Update Date | 17/03/2018 |