Provider Demographics
NPI:1407141609
Name:TEGEGNE, MENBEREMEDHIN ABERA
Entity Type:Individual
Prefix:
First Name:MENBEREMEDHIN
Middle Name:ABERA
Last Name:TEGEGNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5271 HUNTINGTON DR N APT 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-4715
Mailing Address - Country:US
Mailing Address - Phone:858-222-7938
Mailing Address - Fax:
Practice Address - Street 1:427 C ST
Practice Address - Street 2:SUITE 212
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5100
Practice Address - Country:US
Practice Address - Phone:619-238-4180
Practice Address - Fax:619-238-4245
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA722782163W00000X
CA2023004605364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse