Provider Demographics
NPI:1912318916
Name:ABEBE, DAGIMBELAY
Entity type:Individual
Prefix:
First Name:DAGIMBELAY
Middle Name:
Last Name:ABEBE
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 1:3617 BLUE SAGE LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-0978
Mailing Address - Country:US
Mailing Address - Phone:214-598-5864
Mailing Address - Fax:
Practice Address - Street 1:3617 BLUE SAGE LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-0978
Practice Address - Country:US
Practice Address - Phone:214-598-5864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35993038343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)