Provider Demographics
NPI:1386308880
Name:AMANIEL, TEFLON SEMERE (NON EMERGENCY MEDICA)
Entity type:Individual
Prefix:
First Name:TEFLON
Middle Name:SEMERE
Last Name:AMANIEL
Suffix:
Gender:M
Credentials:NON EMERGENCY MEDICA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 TELEGRAPH AVE UNIT 628
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1982
Mailing Address - Country:US
Mailing Address - Phone:310-484-9070
Mailing Address - Fax:510-345-2021
Practice Address - Street 1:5110 TELEGRAPH AVE UNIT 628
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1982
Practice Address - Country:US
Practice Address - Phone:310-484-9070
Practice Address - Fax:510-345-2021
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF2547292172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver