Provider Demographics
NPI:1538520101
Name:HABTESLASSIE, ALMAZ MENGISTU
Entity Type:Individual
Prefix:
First Name:ALMAZ
Middle Name:MENGISTU
Last Name:HABTESLASSIE
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 1:3511 OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3934
Mailing Address - Country:US
Mailing Address - Phone:202-997-2402
Mailing Address - Fax:
Practice Address - Street 1:3511 OLYMPIC ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-3934
Practice Address - Country:US
Practice Address - Phone:202-997-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11700374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide