Provider Demographics
NPI:1396550349
Name:ASSEFAW, WINTA GHEBREYESUS
Entity type:Individual
Prefix:
First Name:WINTA
Middle Name:GHEBREYESUS
Last Name:ASSEFAW
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 1:2840A SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2508
Mailing Address - Country:US
Mailing Address - Phone:510-393-6967
Mailing Address - Fax:
Practice Address - Street 1:2840A SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2508
Practice Address - Country:US
Practice Address - Phone:510-393-6967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF3509731343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)