Provider Demographics
NPI:1437936739
Name:HIKA, GEZAHEGN
Entity Type:Individual
Prefix:
First Name:GEZAHEGN
Middle Name:
Last Name:HIKA
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 1:1005 S JAMAICA ST APT 109
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3162
Mailing Address - Country:US
Mailing Address - Phone:720-388-4894
Mailing Address - Fax:
Practice Address - Street 1:1305 E 10TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-3143
Practice Address - Country:US
Practice Address - Phone:720-388-4894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO330489-1694189269376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty