Provider Demographics
NPI:1073194809
Name:ALAZE, BERHANU TESHAGER I
Entity Type:Individual
Prefix:
First Name:BERHANU
Middle Name:TESHAGER
Last Name:ALAZE
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 WARM SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5983
Mailing Address - Country:US
Mailing Address - Phone:404-566-0966
Mailing Address - Fax:
Practice Address - Street 1:15101 FM 1825 PFLUGERVILLE TX 78660
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-6047
Practice Address - Country:US
Practice Address - Phone:404-566-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)