Provider Demographics
NPI:1174387633
Name:BERHE, TSENA MENGISTU
Entity type:Individual
Prefix:
First Name:TSENA
Middle Name:MENGISTU
Last Name:BERHE
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 1:336 CRESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5647
Mailing Address - Country:US
Mailing Address - Phone:470-535-8895
Mailing Address - Fax:
Practice Address - Street 1:336 CRESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5647
Practice Address - Country:US
Practice Address - Phone:470-535-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)