Healthcare Provider Details

I. General information

NPI: 1477284073
Provider Name (Legal Business Name): LUWAM GEBREMICHAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GRAND AVE
LONG BEACH CA
90815-1765
US

IV. Provider business mailing address

2525 GRAND AVE
LONG BEACH CA
90815-1765
US

V. Phone/Fax

Practice location:
  • Phone: 562-570-7986
  • Fax:
Mailing address:
  • Phone: 562-570-7986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number809463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: