Provider Demographics
NPI:1417598558
Name:MEKONNEN, MAHLET DAWIT
Entity Type:Individual
Prefix:
First Name:MAHLET
Middle Name:DAWIT
Last Name:MEKONNEN
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 1:865 COLE AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-0846
Mailing Address - Country:US
Mailing Address - Phone:408-410-4823
Mailing Address - Fax:
Practice Address - Street 1:865 COLE AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-0846
Practice Address - Country:US
Practice Address - Phone:408-410-4823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician