Provider Demographics
NPI:1154610863
Name:TEFERA, HENOK
Entity type:Individual
Prefix:
First Name:HENOK
Middle Name:
Last Name:TEFERA
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 1:505 PARNASSUS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2204
Mailing Address - Country:US
Mailing Address - Phone:415-353-1238
Mailing Address - Fax:415-353-1799
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:415-353-1238
Practice Address - Fax:415-353-1799
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2023-08-06
Deactivation Date:2018-05-24
Deactivation Code:
Reactivation Date:2018-11-15
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant