Provider Demographics
NPI:1982481248
Name:KITAW, BEKALU TEFERI
Entity Type:Individual
Prefix:
First Name:BEKALU
Middle Name:TEFERI
Last Name:KITAW
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 1:3973 SELMI GRV
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1846
Mailing Address - Country:US
Mailing Address - Phone:510-385-7446
Mailing Address - Fax:
Practice Address - Street 1:3973 SELMI GRV
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-1846
Practice Address - Country:US
Practice Address - Phone:510-385-7446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14340U32278P4000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P4000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPatient Transport