Provider Demographics
NPI:1801419114
Name:BANAFA, ABDULHAMID (DPT)
Entity Type:Individual
Prefix:
First Name:ABDULHAMID
Middle Name:
Last Name:BANAFA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 BERRENDO DR
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-3119
Mailing Address - Country:US
Mailing Address - Phone:408-931-2493
Mailing Address - Fax:
Practice Address - Street 1:42 W CAMPBELL AVE STE 201
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1042
Practice Address - Country:US
Practice Address - Phone:408-370-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT298077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist