Provider Demographics
NPI:1689457053
Name:REGASSA, GUUTAA
Entity Type:Individual
Prefix:
First Name:GUUTAA
Middle Name:
Last Name:REGASSA
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 1:1020 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-1423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1020 WOOD ST
Practice Address - Street 2:1020 WOOD ST
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94076
Practice Address - Country:US
Practice Address - Phone:619-867-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker