Healthcare Provider Details

I. General information

NPI: 1669829867
Provider Name (Legal Business Name): SEBLE ALEMU MAOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 ORCHARD ST
BELMONT MA
02478-3009
US

IV. Provider business mailing address

SEBE ALEMU
ADDIS ABABA NONE
182854
ET

V. Phone/Fax

Practice location:
  • Phone: 617-489-0056
  • Fax:
Mailing address:
  • Phone: 251911482310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: