Provider Demographics
NPI:1750522140
Name:ALEREZA, HAMED (DC)
Entity type:Individual
Prefix:DR
First Name:HAMED
Middle Name:
Last Name:ALEREZA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S EL CAMINO REAL
Mailing Address - Street 2:206
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-1715
Mailing Address - Country:US
Mailing Address - Phone:650-579-7246
Mailing Address - Fax:650-232-0404
Practice Address - Street 1:520 S. EL CAMINO REAL
Practice Address - Street 2:206
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-1715
Practice Address - Country:US
Practice Address - Phone:650-579-7246
Practice Address - Fax:650-232-0404
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACS665AOtherMEDICARE PTAN