Provider Demographics
NPI:1205506797
Name:FEYISSA, DIRIBA
Entity type:Individual
Prefix:
First Name:DIRIBA
Middle Name:
Last Name:FEYISSA
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 1:4040 E MCDOWELL RD STE 412
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4448
Mailing Address - Country:US
Mailing Address - Phone:602-410-9871
Mailing Address - Fax:
Practice Address - Street 1:4040 E MCDOWELL RD STE 412
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4448
Practice Address - Country:US
Practice Address - Phone:602-410-9871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)