Provider Demographics
NPI:1053715359
Name:TESFAZGHI, BIZEN X
Entity type:Individual
Prefix:
First Name:BIZEN
Middle Name:
Last Name:TESFAZGHI
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22040-0641
Mailing Address - Country:US
Mailing Address - Phone:561-414-9754
Mailing Address - Fax:
Practice Address - Street 1:2041 MLK BLVD
Practice Address - Street 2:
Practice Address - City:WASHINGTON,
Practice Address - State:DC
Practice Address - Zip Code:20020
Practice Address - Country:US
Practice Address - Phone:202-547-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14370101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional