Individual
MR. BEKELE T HAIMANOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9528 LOS COCHES COURT, RIVERSIDE, CA 92508
(951) 640-2828
Mailing address
9528 LOS COCHES CT, RIVERSIDE, CA 92508-6814
(951) 640-2828
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA21O33
CA
Other
Enumeration date
10/14/2010
Last updated
10/14/2010
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