Provider Demographics
NPI:1154010726
Name:BOGALE, GETU A
Entity type:Individual
Prefix:
First Name:GETU
Middle Name:A
Last Name:BOGALE
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 1:430 CRAVEN CT
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-7328
Mailing Address - Country:US
Mailing Address - Phone:510-415-9887
Mailing Address - Fax:
Practice Address - Street 1:430 CRAVEN CT
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-7328
Practice Address - Country:US
Practice Address - Phone:510-415-9887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver