Healthcare Provider Details

I. General information

NPI: 1114837119
Provider Name (Legal Business Name): ABDUL HAMID ATAIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11434 B AVE
AUBURN CA
95603-2603
US

IV. Provider business mailing address

1450 KINGSWOOD DR APT 292
ROSEVILLE CA
95678-7900
US

V. Phone/Fax

Practice location:
  • Phone: 530-886-3654
  • Fax:
Mailing address:
  • Phone: 530-886-3654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: