Provider Demographics
NPI:1992918916
Name:AL AMMARY, FAWAZ SAEED OMAR (MD)
Entity type:Individual
Prefix:DR
First Name:FAWAZ
Middle Name:SAEED OMAR
Last Name:AL AMMARY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CITY BLVD W STE 400
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2994
Mailing Address - Country:US
Mailing Address - Phone:714-456-5142
Mailing Address - Fax:714-456-6034
Practice Address - Street 1:101 THE CITY DR S BLDG 29
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-7002
Practice Address - Fax:714-456-2949
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6287207R00000X
PAMD433229207R00000X
OH35 . 090396207R00000X, 208M00000X
CAA99785207R00000X
MDD78764208M00000X
390200000X
CODR.0048953207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program