Provider Demographics
NPI:1013604768
Name:WEDAJO, TEMESGEN
Entity type:Individual
Prefix:
First Name:TEMESGEN
Middle Name:
Last Name:WEDAJO
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 1:10318 W HESS ST
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-1242
Mailing Address - Country:US
Mailing Address - Phone:623-455-0561
Mailing Address - Fax:
Practice Address - Street 1:10318 W HESS ST
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-1242
Practice Address - Country:US
Practice Address - Phone:623-455-0561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)