Provider Demographics
NPI:1790013795
Name:ALEX BAMDAD, INC
Entity Type:Organization
Organization Name:ALEX BAMDAD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:BAMDAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:650-794-1800
Mailing Address - Street 1:1435 HUNTINGTON AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5966
Mailing Address - Country:US
Mailing Address - Phone:650-794-1800
Mailing Address - Fax:650-794-1808
Practice Address - Street 1:1435 HUNTINGTON AVE STE 330
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5966
Practice Address - Country:US
Practice Address - Phone:650-794-1800
Practice Address - Fax:650-794-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111NNO400X261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU65147Medicare UPIN