Healthcare Provider Details

I. General information

NPI: 1922060086
Provider Name (Legal Business Name): OMAR OTHMAN FADEEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 LINCOLN AVE
BUENA PARK CA
90620-4148
US

IV. Provider business mailing address

PO BOX 1746
BREA CA
92822-1746
US

V. Phone/Fax

Practice location:
  • Phone: 714-880-3801
  • Fax: 714-522-7328
Mailing address:
  • Phone: 714-827-6625
  • Fax: 714-827-9726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA44522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: