Kidisti Ghebre Mariam, OD

NPI #1477508331 in Antioch, California

Provider Information

NPI Number: 1477508331
Entity Type: Individual
Name: Kidisti Ghebre Mariam, OD
Gender: Not Specified
Sole Proprietor: Not Answered
Primary Specialty: Optometrist
Credential: OD
Enumeration Date: May 22, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 2201 VERNE ROBERTS CIR
City: Antioch
State: California
ZIP Code: 94509-7911
Phone: (925) 757-1183

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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