Healthcare Provider Details

I. General information

NPI: 1104095058
Provider Name (Legal Business Name): CONRAD HAMAKO, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 GREEN VALLEY RD SUITE 202
FREEDOM CA
95019-3160
US

IV. Provider business mailing address

160 GREEN VALLEY RD SUITE 202
FREEDOM CA
95019-3160
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-2020
  • Fax: 831-728-4739
Mailing address:
  • Phone: 831-728-2020
  • Fax: 831-728-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOOG252850
License Number StateCA

VIII. Authorized Official

Name: CONRAD HAMAKO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 831-728-2020