Provider Demographics
NPI:1417258716
Name:TADESSE, ASMERET (HHA, CNA)
Entity Type:Individual
Prefix:
First Name:ASMERET
Middle Name:
Last Name:TADESSE
Suffix:
Gender:F
Credentials:HHA, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3571 LAFAYETTE ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-2741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 W SAN CARLOS ST
Practice Address - Street 2:#1680
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-2726
Practice Address - Country:US
Practice Address - Phone:408-287-5007
Practice Address - Fax:408-287-3505
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00239682374U00000X
CA00774304376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide