Healthcare Provider Details

I. General information

NPI: 1417683541
Provider Name (Legal Business Name): RAHWA DEBESAY GEBRESELASSIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W MACARTHUR BLVD APT 439
OAKLAND CA
94611-5308
US

IV. Provider business mailing address

PO BOX 3553
OAKLAND CA
94609-0553
US

V. Phone/Fax

Practice location:
  • Phone: 510-552-9421
  • Fax:
Mailing address:
  • Phone: 510-552-9421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: