Healthcare Provider Details

I. General information

NPI: 1770080020
Provider Name (Legal Business Name): BEREKET GEBREEGZIABIHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 UPSHUR ST NW
WASHINGTON DC
20011-5837
US

IV. Provider business mailing address

413 EVARTS ST NE APT 3
WASHINGTON DC
20017-1252
US

V. Phone/Fax

Practice location:
  • Phone: 202-723-0755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13446
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: