Provider Demographics
NPI:1528742673
Name:GEBRESLASSEI, MULUGETA WELDERUFAEL
Entity type:Individual
Prefix:
First Name:MULUGETA
Middle Name:WELDERUFAEL
Last Name:GEBRESLASSEI
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 1:52 N NEWCASTLE CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-1727
Mailing Address - Country:US
Mailing Address - Phone:720-297-7568
Mailing Address - Fax:
Practice Address - Street 1:2175 ACADEMY CIR STE 8
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1682
Practice Address - Country:US
Practice Address - Phone:720-297-7568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COBXGZ98172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver