Provider Demographics
NPI:1538957261
Name:BERHE, LUCHIA TSEHAYE
Entity type:Individual
Prefix:
First Name:LUCHIA
Middle Name:TSEHAYE
Last Name:BERHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25207 FOUR IRON CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-2634
Mailing Address - Country:US
Mailing Address - Phone:210-552-9772
Mailing Address - Fax:
Practice Address - Street 1:25207 FOUR IRON CT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-2634
Practice Address - Country:US
Practice Address - Phone:210-552-9772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver