Healthcare Provider Details

I. General information

NPI: 1154714327
Provider Name (Legal Business Name): SHASHAMANE ETHIOPIA FEDERAL AGENTS ASSOCIATION (THE)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 W 31ST ST # 2161
LOS ANGELES CA
90018-3424
US

IV. Provider business mailing address

405 LEXINGTON AVE CHRYSLER BUILDING 25TH & 26TH FLOORS
NEW YORK NY
10174-0002
US

V. Phone/Fax

Practice location:
  • Phone: 202-765-2230
  • Fax: 877-490-3078
Mailing address:
  • Phone: 202-765-2230
  • Fax: 877-490-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: CLAYTON M. BERNARD EX
Title or Position: CONTROLLER
Credential:
Phone: 202-765-2230