MEDICARE: DR. ETSEMAYE PAULOS AGONAFER M.D., M.P.H, M.S.

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	208M00000X	Hospitalist Physician	A153768	CA
2	207R00000X	Internal Medicine Physician	A153768	CA

General Provider Information

NPI Number	:	1689092215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ETSEMAYE PAULOS AGONAFER M.D., M.P.H, M.S.

Provider Business Mailing Address
First Line	:	10270 ALMAYO AVE APT 208
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3256
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10270 ALMAYO AVE APT 208
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-3256
Country	:	US
Telephone Number	:	310-991-1985
Fax Number	:

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

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	10/10/2022

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