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NPI Code Detail

MEDICARE: NEBIYU SHITANEH EGUALE

MEDICARE: NEBIYU SHITANEH EGUALE
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1396241816
Entity Type Code : Individual
Provider Name (Legal Business Name) : NEBIYU SHITANEH EGUALE
Provider Business Mailing Address
First Line : 11262 CAMPUS ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92350-1727
Country : US
Telephone Number : 909-558-1000
Fax Number :
Provider Business Practice Location Address
First Line : 11262 CAMPUS ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92350-1727
Country : US
Telephone Number : 909-558-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2018
Last Update Date : 05/07/2025

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Directions to “ NEBIYU SHITANEH EGUALE ” Practice Location

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