Provider Demographics
NPI:1164246534
Name:DIRES, TADESSE GEBEYEHU
Entity type:Individual
Prefix:
First Name:TADESSE
Middle Name:GEBEYEHU
Last Name:DIRES
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 1:5822 CHARLOTTE DR APT 1225
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3683
Mailing Address - Country:US
Mailing Address - Phone:415-596-0651
Mailing Address - Fax:
Practice Address - Street 1:5822 CHARLOTTE DR APT 1225
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3683
Practice Address - Country:US
Practice Address - Phone:415-596-0651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)