Provider Demographics
NPI:1861180150
Name:ABRHA, EYOB W
Entity type:Individual
Prefix:MR
First Name:EYOB
Middle Name:W
Last Name:ABRHA
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 1:6074 PIRATES DELIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6973
Mailing Address - Country:US
Mailing Address - Phone:702-945-7474
Mailing Address - Fax:
Practice Address - Street 1:6074 PIRATES DELIGHT AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6973
Practice Address - Country:US
Practice Address - Phone:702-945-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20232765212343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)