Provider Demographics
NPI:1124574579
Name:ABREHA, FITSUM SR (CROSS DME SUPPLIER)
Entity Type:Individual
Prefix:
First Name:FITSUM
Middle Name:
Last Name:ABREHA
Suffix:SR
Gender:M
Credentials:CROSS DME SUPPLIER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 N 28TH STREET
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85339
Mailing Address - Country:US
Mailing Address - Phone:480-277-1016
Mailing Address - Fax:
Practice Address - Street 1:4760 N 28TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4846
Practice Address - Country:US
Practice Address - Phone:480-277-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver