Provider Demographics
NPI:1114688215
Name:SULTAN, ADEN BERHE
Entity Type:Individual
Prefix:
First Name:ADEN
Middle Name:BERHE
Last Name:SULTAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371663
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-1663
Mailing Address - Country:US
Mailing Address - Phone:702-899-3399
Mailing Address - Fax:
Practice Address - Street 1:12266 LORENZO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-6103
Practice Address - Country:US
Practice Address - Phone:702-899-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-01
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care