Provider Demographics
NPI:1437854007
Name:ADMASU, TESFAYE
Entity Type:Individual
Prefix:
First Name:TESFAYE
Middle Name:
Last Name:ADMASU
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 1:955 S HAVANA ST APT 130
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2912
Mailing Address - Country:US
Mailing Address - Phone:303-588-8261
Mailing Address - Fax:
Practice Address - Street 1:955 S HAVANA ST APT 130
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80012-2912
Practice Address - Country:US
Practice Address - Phone:303-588-8261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver