Provider Demographics
NPI:1528522125
Name:ABERRA, ANTENEH T
Entity type:Individual
Prefix:DR
First Name:ANTENEH
Middle Name:T
Last Name:ABERRA
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 1:3501 SHORELINE DR APT 927
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-4492
Mailing Address - Country:US
Mailing Address - Phone:616-284-9131
Mailing Address - Fax:
Practice Address - Street 1:3501 SHORELINE DR APT 927
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-4492
Practice Address - Country:US
Practice Address - Phone:616-284-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)