Provider Demographics
NPI:1598542565
Name:GEBREMESKEL, LUEL H
Entity Type:Individual
Prefix:MR
First Name:LUEL
Middle Name:H
Last Name:GEBREMESKEL
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 1:3959 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3006
Mailing Address - Country:US
Mailing Address - Phone:619-677-0821
Mailing Address - Fax:
Practice Address - Street 1:3959 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-3006
Practice Address - Country:US
Practice Address - Phone:619-677-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB2023009462343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)