Healthcare Provider Details

I. General information

NPI: 1740549526
Provider Name (Legal Business Name): ABERA GEBRE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 05/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S. LABREA AVE
INGLEWOOD CA
90301-3891
US

IV. Provider business mailing address

1959 CLOVERFIELD BLVD #215
SANTA MONICA CA
90404
US

V. Phone/Fax

Practice location:
  • Phone: 310-677-2779
  • Fax: 310-677-2741
Mailing address:
  • Phone: 310-677-2741
  • Fax: 310-677-2779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number190633AN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: