Provider Demographics
NPI:1235915778
Name:TESFAY, YOHANES FISEHAYE
Entity type:Individual
Prefix:
First Name:YOHANES
Middle Name:FISEHAYE
Last Name:TESFAY
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 1:734 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5404
Mailing Address - Country:US
Mailing Address - Phone:720-436-0147
Mailing Address - Fax:
Practice Address - Street 1:734 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5404
Practice Address - Country:US
Practice Address - Phone:720-436-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)