Individual provider Active NPI

Mulu Anbe Gemechu

  • Licensed Vocational Nurse
  • San Pablo, CA
National Provider Identifier
1184473589
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Vocational NurseTaxonomy code 164X00000X
License
712967 Issued in CA
Practice address
101 Arcangel Way
San Pablo, CA 94806-5065
Phone
(510) 932-0555
NPI assigned
May 16, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Vocational Nurse 164X00000X 712967 CA Primary

Addresses

Primary practice location

101 Arcangel Way
San Pablo, CA 94806-5065

Mailing address

1465 Civic CT
Concord, CA 94520-7914
Phone (925) 678-5250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
712967CAMDLicensed Vocational Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1715817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1184473589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1465 CIVIC CT",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945207914",
            "telephone_number": "925-678-5250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 ARCANGEL WAY",
            "city": "SAN PABLO",
            "state": "CA",
            "postal_code": "948065065",
            "telephone_number": "510-932-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GEMECHU",
        "first_name": "MULU",
        "middle_name": "ANBE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-16",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "712967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Pablo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.