Provider Demographics
NPI:1467235531
Name:NEGASI, DIRAR BERHE (DRIVER)
Entity Type:Individual
Prefix:
First Name:DIRAR
Middle Name:BERHE
Last Name:NEGASI
Suffix:
Gender:M
Credentials:DRIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 N TEJON ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1534
Mailing Address - Country:US
Mailing Address - Phone:720-503-7506
Mailing Address - Fax:
Practice Address - Street 1:19 N TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1534
Practice Address - Country:US
Practice Address - Phone:720-503-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO102920744343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)