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General NPI Number Information
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NPI Number | 1598945941
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Entity Type | Individual
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Provider Name | MAHDERE NEGASH RN
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Gender | Female
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 1200 N MAIN ST SUITE # 525
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City | SANTA ANA
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State | CA
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Zip | 92701-3640
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Country | US
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Telephone | 741-480-4628
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Fax | 714-480-4616
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Provider Business Mailing Address
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Address Line | 1200 N MAIN ST SUITE # 525
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City | SANTA ANA
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State | CA
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Zip | 92701-3640
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Country | US
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Telephone | 741-480-4628
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Fax | 714-480-4616
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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 | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 451566
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License Number State | CA
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