Provider Demographics
NPI:1639821580
Name:ABE, TIGIST BULE
Entity Type:Individual
Prefix:
First Name:TIGIST
Middle Name:BULE
Last Name:ABE
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 1:4428 COPELAND AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4852
Mailing Address - Country:US
Mailing Address - Phone:619-259-7406
Mailing Address - Fax:
Practice Address - Street 1:4428 COPELAND AVE APT 7
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4852
Practice Address - Country:US
Practice Address - Phone:619-259-7406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD5918073OtherDRIVER LICENSE