Healthcare Provider Details

I. General information

NPI: 1700259900
Provider Name (Legal Business Name): MEZEGEBU ZEMENE ZERIHUN X ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39155 LIBERTY ST STE G710
FREMONT CA
94538-1525
US

IV. Provider business mailing address

39155 LIBERTY ST # 125A
FREMONT CA
94538-1513
US

V. Phone/Fax

Practice location:
  • Phone: 510-797-2434
  • Fax: 510-793-3972
Mailing address:
  • Phone: 510-795-2434
  • Fax: 510-793-3972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: