Provider Demographics
NPI:1033109145
Name:EBBA, HAILU (MD)
Entity Type:Individual
Prefix:
First Name:HAILU
Middle Name:
Last Name:EBBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3530 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2328
Mailing Address - Country:US
Mailing Address - Phone:213-637-3703
Mailing Address - Fax:213-427-3659
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:SUITE 8211
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:213-637-3703
Practice Address - Fax:213-427-3659
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69622207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF18288Medicare UPIN
CAWG69622AMedicare PIN