Provider Demographics
NPI:1639596901
Name:GEBREMICAEL, YONAS
Entity Type:Individual
Prefix:MR
First Name:YONAS
Middle Name:
Last Name:GEBREMICAEL
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 1:1000 BROADWAY STE 102
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4099
Mailing Address - Country:US
Mailing Address - Phone:510-268-2294
Mailing Address - Fax:
Practice Address - Street 1:1000 BROADWAY STE 102
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4099
Practice Address - Country:US
Practice Address - Phone:510-268-2294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker