Provider Demographics
NPI:1790334993
Name:BIRHANE EKUBAMICHAEK, ASTER
Entity Type:Individual
Prefix:
First Name:ASTER
Middle Name:
Last Name:BIRHANE EKUBAMICHAEK
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 1:6581 LEMON AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-2449
Mailing Address - Country:US
Mailing Address - Phone:310-297-0256
Mailing Address - Fax:
Practice Address - Street 1:6581 LEMON AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-2449
Practice Address - Country:US
Practice Address - Phone:310-297-0256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider