Provider Demographics
NPI:1265927495
Name:HEMPSTEAD, ATIYA I
Entity type:Individual
Prefix:
First Name:ATIYA
Middle Name:I
Last Name:HEMPSTEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7734 LA MANCHA WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-3862
Mailing Address - Country:US
Mailing Address - Phone:916-308-4914
Mailing Address - Fax:
Practice Address - Street 1:7734 LA MANCHA WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-3862
Practice Address - Country:US
Practice Address - Phone:916-308-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA8133724172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver