Provider Demographics
NPI:1982489936
Name:YODORU, ENDALE YACOB
Entity Type:Individual
Prefix:MR
First Name:ENDALE
Middle Name:YACOB
Last Name:YODORU
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 1:6474 N CEYLON CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-7663
Mailing Address - Country:US
Mailing Address - Phone:720-968-3743
Mailing Address - Fax:
Practice Address - Street 1:2175 ACADEMY CIR STE 8
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1682
Practice Address - Country:US
Practice Address - Phone:623-800-2516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)