Provider Demographics
NPI:1427269901
Name:KELEME DAWIT, YEMSERACH BONNIE
Entity type:Individual
Prefix:
First Name:YEMSERACH BONNIE
Middle Name:
Last Name:KELEME DAWIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 AIRPORT WAY
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-8500
Mailing Address - Country:US
Mailing Address - Phone:805-437-8014
Mailing Address - Fax:
Practice Address - Street 1:500 AIRPORT WAY
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-8500
Practice Address - Country:US
Practice Address - Phone:805-437-8014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120331106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist