Provider Demographics
NPI:1417728940
Name:MARTA BERHANE GEBEREGERGIS
Entity Type:Organization
Organization Name:MARTA BERHANE GEBEREGERGIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NON EMERGENCY TRANSPORTATION PROVID
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:BERHANE
Authorized Official - Last Name:GEBREGERGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-926-5796
Mailing Address - Street 1:2000 5TH ST UNIT 546
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1880
Mailing Address - Country:US
Mailing Address - Phone:510-926-5796
Mailing Address - Fax:
Practice Address - Street 1:2000 5TH ST UNIT 546
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1880
Practice Address - Country:US
Practice Address - Phone:510-926-5796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)