Provider Demographics
NPI:1043081888
Name:MAMO, ABIGYA MELAKU
Entity type:Individual
Prefix:
First Name:ABIGYA
Middle Name:MELAKU
Last Name:MAMO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MELAKU
Other - Middle Name:
Other - Last Name:MAMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:995 GATEWAY CENTER WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4550
Mailing Address - Country:US
Mailing Address - Phone:619-398-2156
Mailing Address - Fax:619-398-2168
Practice Address - Street 1:2147 ABBOTT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-2031
Practice Address - Country:US
Practice Address - Phone:619-923-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion