Provider Demographics
NPI:1689351397
Name:GEBREGZIABHER, AZIEB T
Entity Type:Individual
Prefix:
First Name:AZIEB
Middle Name:T
Last Name:GEBREGZIABHER
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 1:1626 MONTELLO AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2751
Mailing Address - Country:US
Mailing Address - Phone:216-647-7845
Mailing Address - Fax:
Practice Address - Street 1:1626 MONTELLO AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2751
Practice Address - Country:US
Practice Address - Phone:216-647-7845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant