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General NPI Number Information
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NPI Number | 1447891791
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Entity Type | Individual
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Provider Name | HABTOM YEBIO ASGHEDE
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Gender | Male
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 3429 LEE RD APT 4
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44120-3630
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Country | US
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Telephone | 206-313-5501
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Fax |
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Provider Business Mailing Address
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Address Line | 3334 W CALDWELL AVE APT 130
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City | VISALIA
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State | CA
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Zip | 93277-8205
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Country | US
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Telephone | 206-313-5501
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 57649
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License Number State | CA
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