Provider Demographics
NPI:1346819026
Name:MAMO, YOSEF ASSEFA
Entity Type:Individual
Prefix:
First Name:YOSEF
Middle Name:ASSEFA
Last Name:MAMO
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 1:1318 MAYNARD DR W APT 465
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3918
Mailing Address - Country:US
Mailing Address - Phone:202-812-5808
Mailing Address - Fax:
Practice Address - Street 1:1318 MAYNARD DR W APT 465
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3918
Practice Address - Country:US
Practice Address - Phone:202-812-5808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)