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MR. MENGESTAB DERI GEBREMESKEL PA-C

Medical >> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1053407106

Individual Registrant:
MR. MENGESTAB DERI GEBREMESKEL PA-C
Gender: M
Not Sole Proprietor

Location and contact information for practice:
25613 CHASE ST  STEVENSON RANCH, CA 91381-1667 US
Tel: 310-268-3890  Fax: 310-268-4611

Contact information for business:
25613 CHASE ST  STEVENSON RANCH, CA 91381-1667 US
Tel: 310-268-3890  Fax: 310-268-4611

Registration Information:
NPI: 1053407106
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363AM0700XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Medical

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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