Provider Demographics
NPI:1730774225
Name:ANDU, SELIM SEYOUM MEBRAHTU III
Entity type:Individual
Prefix:
First Name:SELIM
Middle Name:SEYOUM MEBRAHTU
Last Name:ANDU
Suffix:III
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 1:523 BUENA VISTA AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-2023
Mailing Address - Country:US
Mailing Address - Phone:510-383-0724
Mailing Address - Fax:
Practice Address - Street 1:523 BUENA VISTA AVE APT 206
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2023
Practice Address - Country:US
Practice Address - Phone:510-383-0724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program