Provider Demographics
NPI:1811557994
Name:AKLILU, KEBRON
Entity Type:Individual
Prefix:MS
First Name:KEBRON
Middle Name:
Last Name:AKLILU
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 1:10108 SW 13TH ST APT 5-208
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5018
Mailing Address - Country:US
Mailing Address - Phone:609-576-6579
Mailing Address - Fax:
Practice Address - Street 1:10108 SW 13TH ST APT 5-208
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-5018
Practice Address - Country:US
Practice Address - Phone:609-576-6579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program