Individual
HAGOS KIFLAY TEKLAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6991 BALBOA AVE RM 70, SAN DIEGO, CA 92111-3447
(858) 496-8232
(858) 496-8234
Mailing address
6991 BALBOA AVE RM 70, SAN DIEGO, CA 92111-3447
(858) 496-8232
(858) 496-8234
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
PHN559278
CA
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
RN95152885
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHN559278
THE STATE OF CALIFORNIA
CA
Enumeration date
06/03/2020
Last updated
06/03/2020
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