Provider Demographics
NPI:1053407106
Name:GEBREMESKEL, MENGESTAB DERI (PA-C)
Entity type:Individual
Prefix:MR
First Name:MENGESTAB
Middle Name:DERI
Last Name:GEBREMESKEL
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:25613 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1667
Mailing Address - Country:US
Mailing Address - Phone:310-268-3890
Mailing Address - Fax:310-268-4611
Practice Address - Street 1:25613 CHASE ST
Practice Address - Street 2:
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-1667
Practice Address - Country:US
Practice Address - Phone:310-268-3890
Practice Address - Fax:310-268-4611
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical