Provider Demographics
NPI:1447891791
Name:ASGHEDE, HABTOM YEBIO
Entity type:Individual
Prefix:
First Name:HABTOM
Middle Name:YEBIO
Last Name:ASGHEDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 W CALDWELL AVE APT 130
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8205
Mailing Address - Country:US
Mailing Address - Phone:206-313-5501
Mailing Address - Fax:
Practice Address - Street 1:3429 LEE RD APT 4
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-3630
Practice Address - Country:US
Practice Address - Phone:206-313-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57649363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant