Active NPI
Dereje Tesfaye, CNMT
- Nuclear Medicine Technology Radiologic Technologist
- Los Angeles, CA
National Provider Identifier
1255523338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nuclear Medicine Technology Radiologic Technologist
- License
- RHN2719
- Practice address
- 5715 Camerford Ave Apt 106
Los Angeles, CA 90038-3944 - Phone
- (213) 804-5904
- NPI assigned
- Aug 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nuclear Medicine Technology Radiologic Technologist | 2471N0900X | RHN2719 | CA | Primary |
Addresses
Primary practice location
5715 Camerford Ave Apt 106
Los Angeles, CA 90038-3944
Mailing address
5715 Camerford Ave Apt 106
Los Angeles, CA 90038-3944
Phone (213) 804-5904
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RHN2719 | CA | MD | Nuclear Medicine Technology Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186963200000",
"number": "1255523338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5715 CAMERFORD AVE APT 106",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900383944",
"telephone_number": "213-804-5904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5715 CAMERFORD AVE APT 106",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900383944",
"telephone_number": "213-804-5904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TESFAYE",
"first_name": "DEREJE",
"credential": "CNMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-13",
"last_updated": "2007-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "2471N0900X",
"taxonomy_group": "",
"desc": "Radiologic Technologist, Nuclear Medicine Technology",
"state": "CA",
"license": "RHN2719",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.