Provider Demographics
NPI:1316988785
Name:AL-BANDER, HAMOUDI (MD)
Entity type:Individual
Prefix:DR
First Name:HAMOUDI
Middle Name:
Last Name:AL-BANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13851 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2627
Mailing Address - Country:US
Mailing Address - Phone:510-351-9373
Mailing Address - Fax:510-351-0616
Practice Address - Street 1:13851 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2631
Practice Address - Country:US
Practice Address - Phone:510-351-9373
Practice Address - Fax:510-351-0616
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30845174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-3075855OtherTAX ID
CAGR0045150Medicaid
CAZZZ15026ZMedicare ID - Type Unspecified