MEDICARE: HABTOM YEBIO ASGHEDE

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	363A00000X	Physician Assistant	57649	CA

General Provider Information

NPI Number	:	1447891791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HABTOM YEBIO ASGHEDE

Provider Business Mailing Address
First Line	:	3334 W CALDWELL AVE APT 130
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93277-8205
Country	:	US
Telephone Number	:	206-313-5501
Fax Number	:

Provider Business Practice Location Address
First Line	:	3429 LEE RD APT 4
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-3630
Country	:	US
Telephone Number	:	206-313-5501
Fax Number	:

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

Provider Enumeration Date	:	10/07/2019
Last Update Date	:	01/24/2020

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