Provider Demographics
NPI:1174932487
Name:HAMOUDAH, BASHIR
Entity type:Individual
Prefix:DR
First Name:BASHIR
Middle Name:
Last Name:HAMOUDAH
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 1:11 CALLE MEDICO
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4705
Mailing Address - Country:US
Mailing Address - Phone:505-983-3037
Mailing Address - Fax:505-982-3737
Practice Address - Street 1:11 CALLE MEDICO
Practice Address - Street 2:SUITE 3
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4705
Practice Address - Country:US
Practice Address - Phone:505-983-3037
Practice Address - Fax:505-982-3737
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor