Provider Demographics
NPI:1740007624
Name:TEKELEAREGAY, MERON G (FNP)
Entity type:Individual
Prefix:
First Name:MERON
Middle Name:G
Last Name:TEKELEAREGAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90747-0001
Mailing Address - Country:US
Mailing Address - Phone:310-243-3693
Mailing Address - Fax:
Practice Address - Street 1:1000 E VICTORIA ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90747-0001
Practice Address - Country:US
Practice Address - Phone:310-243-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF08240055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily