MEDICARE: NIGIST ASFAHA MD

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	207L00000X	Anesthesiology Physician	C52081	CA

General Provider Information

NPI Number	:	1669462115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIGIST ASFAHA MD

Provider Business Mailing Address
First Line	:	1642 N CURSON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-2806
Country	:	US
Telephone Number	:	760-368-7712
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 WHITE FEATHER RD
Second Line	:
City	:	JOSHUA TREE
State	:	CA
Zip	:	92252
Country	:	US
Telephone Number	:	760-366-3711
Fax Number	:

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	10/17/2018

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