Provider Demographics
NPI:1902664915
Name:KHADER, AMBARENE
Entity type:Individual
Prefix:
First Name:AMBARENE
Middle Name:
Last Name:KHADER
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 1:4133 MOHR AVE STE F
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4750
Mailing Address - Country:US
Mailing Address - Phone:925-587-3240
Mailing Address - Fax:925-484-8443
Practice Address - Street 1:4133 MOHR AVE STE F
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4750
Practice Address - Country:US
Practice Address - Phone:925-587-3240
Practice Address - Fax:925-484-8443
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist