Provider Demographics
NPI:1134500978
Name:GEBRAI, HABEN
Entity type:Individual
Prefix:
First Name:HABEN
Middle Name:
Last Name:GEBRAI
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 1:2253 S EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1521
Mailing Address - Country:US
Mailing Address - Phone:720-490-8667
Mailing Address - Fax:
Practice Address - Street 1:2253 S EAGLE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1521
Practice Address - Country:US
Practice Address - Phone:720-490-8667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COB9966172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver