Provider Demographics
NPI:1396372223
Name:TILAHUN, NIGIST
Entity Type:Individual
Prefix:
First Name:NIGIST
Middle Name:
Last Name:TILAHUN
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 1:10210 SAN DIEGO MISSION RD APT 64
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2179
Mailing Address - Country:US
Mailing Address - Phone:619-376-5504
Mailing Address - Fax:
Practice Address - Street 1:9943 JEREMY ST
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-1948
Practice Address - Country:US
Practice Address - Phone:619-227-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF2132543OtherDRIVER LICENSE