Provider Demographics
NPI:1770061483
Name:HAMDAN, ADEL AHMAD
Entity type:Individual
Prefix:
First Name:ADEL
Middle Name:AHMAD
Last Name:HAMDAN
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 1:9354 LAGUNA POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4087
Mailing Address - Country:US
Mailing Address - Phone:276-237-8039
Mailing Address - Fax:
Practice Address - Street 1:1995 ZINFANDEL DR STE 205
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2862
Practice Address - Country:US
Practice Address - Phone:916-635-9199
Practice Address - Fax:916-635-7490
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1284722225100000X
VA2305206998225100000X
CA295090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist