Provider Demographics
NPI:1003906553
Name:TESFAY, ZELALEM (MD)
Entity Type:Individual
Prefix:
First Name:ZELALEM
Middle Name:
Last Name:TESFAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7126 PACIFIC BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4775
Mailing Address - Country:US
Mailing Address - Phone:323-582-9330
Mailing Address - Fax:323-582-8903
Practice Address - Street 1:7126 PACIFIC BLVD
Practice Address - Street 2:STE B
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4720
Practice Address - Country:US
Practice Address - Phone:323-582-9330
Practice Address - Fax:323-582-8903
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG76854207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G768544Medicaid
CA05D0985404OtherCLIA #