Provider Demographics
NPI:1326410051
Name:TAFESSE, BELAYNEH
Entity type:Individual
Prefix:
First Name:BELAYNEH
Middle Name:
Last Name:TAFESSE
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 1:507 TISH CIR APT 507
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-2429
Mailing Address - Country:US
Mailing Address - Phone:817-308-1178
Mailing Address - Fax:815-301-8517
Practice Address - Street 1:507 TISH CIR APT 507
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-2429
Practice Address - Country:US
Practice Address - Phone:817-308-1178
Practice Address - Fax:815-301-8517
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver