Individual
ASSEFA TAYE DESTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4774 CAMPBELL AVE UNIT 12, SAN JOSE, CA 95130-1857
(408) 379-9938
Mailing address
4774 CAMPBELL AVE UNIT 12, SAN JOSE, CA 95130-1857
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
09/09/2008
Last updated
09/09/2008
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