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General NPI Number Information
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NPI Number | 1760276778
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Entity Type | Individual
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Provider Name | HAMID BAHRAMAND
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Gender | Male
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 975 S FAIRMONT AVE
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City | LODI
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State | CA
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Zip | 95240-5118
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Country | US
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Telephone | 209-334-3411
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Fax |
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Provider Business Mailing Address
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Address Line | 6007 WINDBREAKER WAY
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City | SACRAMENTO
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State | CA
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Zip | 95823-6912
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Country | US
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Telephone | 916-559-1419
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95034599
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License Number State | CA
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