Provider Demographics
NPI:1073033841
Name:HAGOS, NAHOM BERHE
Entity Type:Individual
Prefix:
First Name:NAHOM
Middle Name:BERHE
Last Name:HAGOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 GARDELLA AVE APT 522
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-1037
Mailing Address - Country:US
Mailing Address - Phone:202-642-7503
Mailing Address - Fax:
Practice Address - Street 1:1298 HIGHGATE CT
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-0762
Practice Address - Country:US
Practice Address - Phone:775-276-9979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst