Provider Demographics
NPI:1740315324
Name:SEMERE, LUWAM GEBREMUSIE
Entity type:Individual
Prefix:
First Name:LUWAM
Middle Name:GEBREMUSIE
Last Name:SEMERE
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 1:200 MEDICAL PLZ
Mailing Address - Street 2:STE 430
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-0001
Mailing Address - Country:US
Mailing Address - Phone:310-794-7274
Mailing Address - Fax:
Practice Address - Street 1:5767 W CENTURY BLVD
Practice Address - Street 2:STE 400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5631
Practice Address - Country:US
Practice Address - Phone:310-794-7274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111761174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1117610Medicaid
CA0A1117610Medicaid