Provider Demographics
NPI:1679660625
Name:HAGOS, ZELALEM B
Entity Type:Individual
Prefix:MS
First Name:ZELALEM
Middle Name:B
Last Name:HAGOS
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 1:15545 BELLFLOWER BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-3859
Mailing Address - Country:US
Mailing Address - Phone:562-866-8956
Mailing Address - Fax:562-461-2893
Practice Address - Street 1:17800 WOODRUFF AVE
Practice Address - Street 2:SUITE F
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-7029
Practice Address - Country:US
Practice Address - Phone:562-866-8956
Practice Address - Fax:562-461-2893
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 193631041C0700X
CA294171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical