MEDICARE: SELAM SAHLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	56970	CA

General Provider Information

NPI Number	:	1144874876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELAM SAHLE

Provider Business Mailing Address
First Line	:	2880 ATLANTIC AVE STE 110
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1739
Country	:	US
Telephone Number	:	562-424-4404
Fax Number	:

Provider Business Practice Location Address
First Line	:	2880 ATLANTIC AVE STE 110
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1739
Country	:	US
Telephone Number	:	562-444-4404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2019
Last Update Date	:	07/31/2019

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Directions to “ SELAM SAHLE ” Practice Location

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