Provider Demographics
NPI:1679387591
Name:BRHANE, GEBRETSADIK
Entity type:Individual
Prefix:
First Name:GEBRETSADIK
Middle Name:
Last Name:BRHANE
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 1:4743 N 16TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-3624
Mailing Address - Country:US
Mailing Address - Phone:623-219-9820
Mailing Address - Fax:
Practice Address - Street 1:4743 N 16TH AVE APT 4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3624
Practice Address - Country:US
Practice Address - Phone:623-219-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)