Provider Demographics
NPI:1679675029
Name:HAMAKO, CONRAD (MD)
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:
Last Name:HAMAKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 GREEN VALLEY ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-3160
Mailing Address - Country:US
Mailing Address - Phone:931-724-1353
Mailing Address - Fax:831-724-9551
Practice Address - Street 1:160 GREEN VALLEY ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3160
Practice Address - Country:US
Practice Address - Phone:931-724-1353
Practice Address - Fax:831-724-9551
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G252850207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G252850Medicaid
CA00G252850Medicaid
CA00G252850Medicare ID - Type Unspecified