Provider Demographics
NPI:1902308364
Name:NEGATU, YENESAW WASIHUN
Entity Type:Individual
Prefix:MR
First Name:YENESAW
Middle Name:WASIHUN
Last Name:NEGATU
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 1:4005 N BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-3812
Mailing Address - Country:US
Mailing Address - Phone:559-960-7631
Mailing Address - Fax:559-222-4693
Practice Address - Street 1:4005 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-3812
Practice Address - Country:US
Practice Address - Phone:559-960-7631
Practice Address - Fax:559-222-4693
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)