Provider Demographics
NPI:1487486437
Name:GUANGUL, TIRUWORK ABEBE
Entity type:Individual
Prefix:
First Name:TIRUWORK
Middle Name:ABEBE
Last Name:GUANGUL
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 1:17074 COBBLE CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-8858
Mailing Address - Country:US
Mailing Address - Phone:408-396-4045
Mailing Address - Fax:
Practice Address - Street 1:17074 COBBLE CREEK WAY
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-8858
Practice Address - Country:US
Practice Address - Phone:408-396-4045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220006164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse