Provider Demographics
NPI:1760752794
Name:HAMOR, WAYNE TODD
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:TODD
Last Name:HAMOR
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 1:4791 BORDWELL DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-2406
Mailing Address - Country:US
Mailing Address - Phone:408-771-6749
Mailing Address - Fax:
Practice Address - Street 1:4791 BORDWELL DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-2406
Practice Address - Country:US
Practice Address - Phone:408-771-6749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)