Provider Demographics
NPI:1780143339
Name:HABTEMARIAM, SENAIT
Entity type:Individual
Prefix:
First Name:SENAIT
Middle Name:
Last Name:HABTEMARIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SENAIT
Other - Middle Name:
Other - Last Name:HABTEMARIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12266 LORENZO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-6103
Mailing Address - Country:US
Mailing Address - Phone:862-400-3564
Mailing Address - Fax:
Practice Address - Street 1:12266 LORENZO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-6103
Practice Address - Country:US
Practice Address - Phone:862-400-3564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator