Provider Demographics
NPI:1689254336
Name:YETBAREK, MULUWORK A
Entity Type:Individual
Prefix:
First Name:MULUWORK
Middle Name:A
Last Name:YETBAREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4157 41ST ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1486
Mailing Address - Country:US
Mailing Address - Phone:619-340-7320
Mailing Address - Fax:
Practice Address - Street 1:9943 JEREMY ST
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-1948
Practice Address - Country:US
Practice Address - Phone:619-227-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1311151OtherDRIVER LICENSE