Provider Demographics
NPI:1417547043
Name:TIRUNEH, ESUYAWKAL TAMERU
Entity Type:Individual
Prefix:
First Name:ESUYAWKAL
Middle Name:TAMERU
Last Name:TIRUNEH
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 1:312 W FLORAL DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6437
Mailing Address - Country:US
Mailing Address - Phone:323-416-8255
Mailing Address - Fax:
Practice Address - Street 1:2500 W FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-5144
Practice Address - Country:US
Practice Address - Phone:323-750-2083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016151363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily