Provider Demographics
NPI:1326410853
Name:GEBREZGABHER, AMANUAL H
Entity Type:Individual
Prefix:
First Name:AMANUAL
Middle Name:H
Last Name:GEBREZGABHER
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 1:8822 E FLORIDA AVE APT 114
Mailing Address - Street 2:SUITE NUMBER 114
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2819
Mailing Address - Country:US
Mailing Address - Phone:720-400-2030
Mailing Address - Fax:
Practice Address - Street 1:8822 E FLORIDA AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2868
Practice Address - Country:US
Practice Address - Phone:720-400-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO475297841172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver