Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | G76854 | CA |
NPI | 1003906553 |
---|---|
Provider Name | Zelalem Tesfay |
First Address | Huntington Park, CA 90255-4775 |
Second Address | Huntington Park, CA 90255-4720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 04/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G768544 | (05) | CA |
05D0985404 | CLIA # (01) | CA |