Healthcare Provider Details

I. General information

NPI: 1467394221
Provider Name (Legal Business Name): ASMAMAW ANSHEBO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 SPECTRUM AVE SW
RIO RANCHO NM
87124-1888
US

IV. Provider business mailing address

153 SPECTRUM AVE SW
RIO RANCHO NM
87124-1888
US

V. Phone/Fax

Practice location:
  • Phone: 323-404-2379
  • Fax:
Mailing address:
  • Phone: 323-404-2379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: