Provider Demographics
NPI:1871744250
Name:ABRAHA, HOMIB KIDANE
Entity type:Individual
Prefix:
First Name:HOMIB
Middle Name:KIDANE
Last Name:ABRAHA
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 1:1800 EVANS LN
Mailing Address - Street 2:4104
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-6234
Mailing Address - Country:US
Mailing Address - Phone:408-250-4143
Mailing Address - Fax:
Practice Address - Street 1:1800 EVANS LN
Practice Address - Street 2:4104
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-6234
Practice Address - Country:US
Practice Address - Phone:408-250-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health