Provider Demographics
NPI:1811381833
Name:TAFESSE, SURAFEL GEBEYEHU
Entity Type:Individual
Prefix:DR
First Name:SURAFEL
Middle Name:GEBEYEHU
Last Name:TAFESSE
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 1:2112 TRAWOOD DR
Mailing Address - Street 2:SUITE # B9
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3372
Mailing Address - Country:US
Mailing Address - Phone:915-595-2788
Mailing Address - Fax:
Practice Address - Street 1:2112 TRAWOOD DR
Practice Address - Street 2:SUITE # B9
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3372
Practice Address - Country:US
Practice Address - Phone:915-595-2788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist