Healthcare Provider Details

I. General information

NPI: 1356445522
Provider Name (Legal Business Name): LAMIS AL-AHMAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date: 01/23/2025
Reactivation Date: 02/10/2025

III. Provider practice location address

1860 N WESTERN AVE STE 101
LOS ANGELES CA
90027-3491
US

IV. Provider business mailing address

24422 AVENIDA DE LA CARLOTA STE 300
LAGUNA HILLS CA
92653-3628
US

V. Phone/Fax

Practice location:
  • Phone: 323-825-9223
  • Fax: 323-978-4883
Mailing address:
  • Phone: 949-599-2434
  • Fax: 949-599-2430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301062743
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC152422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: