Provider Demographics
NPI:1063814887
Name:HIKSSA, ADDIS ALEM (RCFE ADMINISTRATOR)
Entity Type:Individual
Prefix:MR
First Name:ADDIS ALEM
Middle Name:
Last Name:HIKSSA
Suffix:
Gender:M
Credentials:RCFE ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7364 EL CAJON BLVD
Mailing Address - Street 2:#209
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-1866
Mailing Address - Country:US
Mailing Address - Phone:858-215-1828
Mailing Address - Fax:
Practice Address - Street 1:7364 EL CAJON BLVD
Practice Address - Street 2:#209
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-1866
Practice Address - Country:US
Practice Address - Phone:858-215-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care