Provider Demographics
NPI:1336779453
Name:GETACHEW, SOLOMON
Entity Type:Individual
Prefix:
First Name:SOLOMON
Middle Name:
Last Name:GETACHEW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 S WINCHESTER BLVD APT 71
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4323
Mailing Address - Country:US
Mailing Address - Phone:510-570-5928
Mailing Address - Fax:
Practice Address - Street 1:1324 S WINCHESTER BLVD APT 71
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4323
Practice Address - Country:US
Practice Address - Phone:510-570-5928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No376J00000XNursing Service Related ProvidersHomemaker