Individual
BENIYAM DEGAGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6881 STANTON AVE, BUENA PARK, CA 90621-3648
(424) 386-5957
Mailing address
8111 STANFORD AVE SPC 134, GARDEN GROVE, CA 92841-4363
(424) 386-5957
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
F1371238
CA
Other
Enumeration date
01/17/2024
Last updated
01/17/2024
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