Provider Demographics
NPI:1801783311
Name:GEBRENEGUS, EFRAM
Entity type:Individual
Prefix:
First Name:EFRAM
Middle Name:
Last Name:GEBRENEGUS
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 1:2939 E ROOSEVELT ST APT 57
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-5048
Mailing Address - Country:US
Mailing Address - Phone:602-900-3949
Mailing Address - Fax:
Practice Address - Street 1:2939 E ROOSEVELT ST APT 57
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-5048
Practice Address - Country:US
Practice Address - Phone:602-900-3949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty