Provider Demographics
NPI:1093418154
Name:GELETA, YOMIYOU
Entity Type:Individual
Prefix:
First Name:YOMIYOU
Middle Name:
Last Name:GELETA
Suffix:
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 1:901 HARRY S TRUMAN AVE
Mailing Address - Street 2:SUITE H-4-N-217
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5477
Mailing Address - Country:US
Mailing Address - Phone:240-677-0236
Mailing Address - Fax:
Practice Address - Street 1:901 HARRY S TRUMAN AVE
Practice Address - Street 2:SUITE H-4-N-217
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5477
Practice Address - Country:US
Practice Address - Phone:240-677-0236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty