Healthcare Provider Details

I. General information

NPI: 1356473631
Provider Name (Legal Business Name): MICAEL SIUM GEBREHIWOT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 W WOODLAND DR
ANAHEIM CA
92801-2637
US

IV. Provider business mailing address

2531 W WOODLAND DR
ANAHEIM CA
92801-2637
US

V. Phone/Fax

Practice location:
  • Phone: 714-226-9888
  • Fax:
Mailing address:
  • Phone: 714-226-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: