Provider Demographics
NPI:1417683541
Name:GEBRESELASSIE, RAHWA DEBESAY
Entity Type:Individual
Prefix:
First Name:RAHWA
Middle Name:DEBESAY
Last Name:GEBRESELASSIE
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:PO BOX 3553
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-0553
Mailing Address - Country:US
Mailing Address - Phone:510-552-9421
Mailing Address - Fax:
Practice Address - Street 1:215 W MACARTHUR BLVD APT 439
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5308
Practice Address - Country:US
Practice Address - Phone:510-552-9421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide