Provider Demographics
NPI:1346414554
Name:HEMODE, ABADALLAH M
Entity Type:Individual
Prefix:
First Name:ABADALLAH
Middle Name:M
Last Name:HEMODE
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 1:3974 EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2665
Mailing Address - Country:US
Mailing Address - Phone:510-633-1100
Mailing Address - Fax:
Practice Address - Street 1:3974 EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2665
Practice Address - Country:US
Practice Address - Phone:510-633-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3670694261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service