MEDICARE: KESANET NUGUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1003510942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KESANET NUGUSE

Provider Business Mailing Address
First Line	:	1880 FAIRWAY DR
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-5629
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2017 CONSTITUTION CT
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94579-1983
Country	:	US
Telephone Number	:	510-626-3070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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Directions to “ KESANET NUGUSE ” Practice Location

Language	Start Address	Practice Location

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