Immanuel Ugonnia Selassie I

NPI 1053601039 - Dentist - 122300000X

NPI Details
NPI 1053601039
Gender Male
Enumeration Date 04/12/2011
Last Updated 02/28/2014
Entity Type Individual
Active Over 5 years ago
Practice Location
2430 FAIR OAKS BLVD (APT 120)
SACRAMENTO CA, 95825-5129, US
Phone (206) 384-6915
Fax
Business Location
2322 FRUITVALE AVE
OAKLAND CA, 94601-2534, US
Phone (510) 520-4327
Fax
Toxanomy
Taxonomy Code 122300000X
License State California
License Number 56829
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According to our database, Dr. Immanuel Ugonnia Selassie I NPI is 1053601039, taxonomy code is 122300000X and license number is 56829, license state is located at California. Immanuel Ugonnia Selassie I physically located at 2430 Fair Oaks Blvd (apt 120), Sacramento CA, 95825-5129. NPI Number Immanuel Ugonnia Selassie I has the Individual type.

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1053601039 NPI number is provided on an as is basis without warranty of any kind. 1053601039 is maintained by the National Plan & Provider Enumeration System. The contents of Immanuel Ugonnia Selassie I are for informational purposes only.