Provider Demographics
NPI:1346080140
Name:AMOSSA, DAWIT ABERRA (ATC)
Entity type:Individual
Prefix:
First Name:DAWIT
Middle Name:ABERRA
Last Name:AMOSSA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S LA FAYETTE PARK PL APT 415
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4630
Mailing Address - Country:US
Mailing Address - Phone:310-343-9312
Mailing Address - Fax:
Practice Address - Street 1:315 S LA FAYETTE PARK PL APT 415
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4630
Practice Address - Country:US
Practice Address - Phone:310-343-9312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program