Provider Demographics
NPI:1477215705
Name:ASEGD, NAHOM
Entity Type:Individual
Prefix:
First Name:NAHOM
Middle Name:
Last Name:ASEGD
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 1:1024 N 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-1525
Mailing Address - Country:US
Mailing Address - Phone:602-831-8279
Mailing Address - Fax:
Practice Address - Street 1:1024 N 62ND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-1525
Practice Address - Country:US
Practice Address - Phone:602-831-8279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator