Provider Demographics
NPI:1013441229
Name:ABRAHA, TEKLEHAIMANOT (DNP)
Entity type:Individual
Prefix:DR
First Name:TEKLEHAIMANOT
Middle Name:
Last Name:ABRAHA
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 B ST # 162
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4108
Mailing Address - Country:US
Mailing Address - Phone:415-619-4719
Mailing Address - Fax:
Practice Address - Street 1:423 BROADWAY
Practice Address - Street 2:SUITE #604
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1905
Practice Address - Country:US
Practice Address - Phone:415-619-4719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95005443OtherFURNISHING NUMBER