Provider Demographics
NPI:1265218846
Name:DAREBO, TESFA
Entity type:Individual
Prefix:
First Name:TESFA
Middle Name:
Last Name:DAREBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TESFATSEIYON
Other - Middle Name:
Other - Last Name:DAREBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4507 ESPANA WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-6651
Mailing Address - Country:US
Mailing Address - Phone:720-589-9347
Mailing Address - Fax:
Practice Address - Street 1:4507 ESPANA WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-6651
Practice Address - Country:US
Practice Address - Phone:720-589-9347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)