MEDICARE: EYOUEL HAILU

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	225X00000X	Occupational Therapist	21428	CA

General Provider Information

NPI Number	:	1467105502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EYOUEL HAILU

Provider Business Mailing Address
First Line	:	2901 S SEPULVEDA BLVD APT 366
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3993
Country	:	US
Telephone Number	:	818-602-8571
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 S SEPULVEDA BLVD APT 366
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3993
Country	:	US
Telephone Number	:	818-602-8571
Fax Number	:

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

Provider Enumeration Date	:	01/29/2022
Last Update Date	:	01/29/2022

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Directions to “ EYOUEL HAILU ” Practice Location

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