Provider Demographics
NPI:1205525383
Name:GEBREZGIABHER, MERIH ESTIFANOS
Entity type:Individual
Prefix:
First Name:MERIH
Middle Name:ESTIFANOS
Last Name:GEBREZGIABHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MERIH
Other - Middle Name:E
Other - Last Name:GEBREZGIABHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7566 W KEIM DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-4244
Mailing Address - Country:US
Mailing Address - Phone:480-220-3554
Mailing Address - Fax:602-888-2497
Practice Address - Street 1:1120 W SECOND ST
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-3108
Practice Address - Country:US
Practice Address - Phone:480-220-3554
Practice Address - Fax:602-888-2497
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)