Healthcare Provider Details

I. General information

NPI: 1699462622
Provider Name (Legal Business Name): HABTAMU MERKEBA MEKURIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 SUNNYSIDE AVE N
SEATTLE WA
98103-6939
US

IV. Provider business mailing address

4516 SUNNYSIDE AVE N
SEATTLE WA
98103-6939
US

V. Phone/Fax

Practice location:
  • Phone: 206-698-9870
  • Fax:
Mailing address:
  • Phone: 206-698-9870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License NumberWDL43PT3G33B
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: