Provider Demographics
NPI:1184473589
Name:GEMECHU, MULU ANBE
Entity type:Individual
Prefix:
First Name:MULU
Middle Name:ANBE
Last Name:GEMECHU
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 1:1465 CIVIC CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-7914
Mailing Address - Country:US
Mailing Address - Phone:925-678-5250
Mailing Address - Fax:
Practice Address - Street 1:101 ARCANGEL WAY
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-5065
Practice Address - Country:US
Practice Address - Phone:510-932-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA712967164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse