Provider Demographics
NPI:1821853581
Name:SIUM, RODAS DAWIT
Entity Type:Individual
Prefix:
First Name:RODAS
Middle Name:DAWIT
Last Name:SIUM
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 1:1601 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2712
Mailing Address - Country:US
Mailing Address - Phone:415-456-6655
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2712
Practice Address - Country:US
Practice Address - Phone:415-456-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)