Provider Demographics
NPI:1568151504
Name:TAMRAT, YALEW
Entity Type:Individual
Prefix:
First Name:YALEW
Middle Name:
Last Name:TAMRAT
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 1:4185 E BONANZA RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-4402
Mailing Address - Country:US
Mailing Address - Phone:480-548-3307
Mailing Address - Fax:
Practice Address - Street 1:4040 E MCDOWELL RD STE 405
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4448
Practice Address - Country:US
Practice Address - Phone:202-415-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD08910787172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver