Provider Demographics
NPI:1558682195
Name:BEKELE, METASEBIA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:METASEBIA
Middle Name:
Last Name:BEKELE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080
Mailing Address - Country:US
Mailing Address - Phone:530-527-0350
Mailing Address - Fax:530-529-3881
Practice Address - Street 1:1850 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080
Practice Address - Country:US
Practice Address - Phone:530-527-0350
Practice Address - Fax:530-529-3881
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105475363A00000X
CA52895363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GQ872ZOtherWELLMED MEDICAL MANAGEMENT OF FLORIDA INC