Provider Demographics
NPI:1659083889
Name:MIHRETE, YBELTAL D
Entity Type:Individual
Prefix:
First Name:YBELTAL
Middle Name:D
Last Name:MIHRETE
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 SANDERS VW
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-3999
Mailing Address - Country:US
Mailing Address - Phone:240-614-1633
Mailing Address - Fax:
Practice Address - Street 1:4185 SANDERS VW
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-3999
Practice Address - Country:US
Practice Address - Phone:240-614-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)