Provider Demographics
NPI:1912612946
Name:WONDIMU, KIRUBEL ABEBE (CEO)
Entity Type:Individual
Prefix:
First Name:KIRUBEL
Middle Name:ABEBE
Last Name:WONDIMU
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S CENTRAL EXPY STE 7J
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7422
Mailing Address - Country:US
Mailing Address - Phone:916-370-8901
Mailing Address - Fax:
Practice Address - Street 1:777 S CENTRAL EXPY STE 7J
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7422
Practice Address - Country:US
Practice Address - Phone:916-370-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)