Provider Demographics
NPI:1467253401
Name:DARGIE, NITSUH KASSAYE
Entity type:Individual
Prefix:
First Name:NITSUH
Middle Name:KASSAYE
Last Name:DARGIE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 737
Mailing Address - Street 2:
Mailing Address - City:SAN JOAQUIN
Mailing Address - State:CA
Mailing Address - Zip Code:93660-0737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 737
Practice Address - Street 2:
Practice Address - City:SAN JOAQUIN
Practice Address - State:CA
Practice Address - Zip Code:93660-0737
Practice Address - Country:US
Practice Address - Phone:559-203-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program