Healthcare Provider Details

I. General information

NPI: 1770767139
Provider Name (Legal Business Name): OMAR MEDHAT AMR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BUILDING 200 SUITE 710 RT 128-01
ORANGE CA
92868-3201
US

IV. Provider business mailing address

7822 SEABREEZE DR
HUNTINGTON BEACH CA
92648-5447
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5922
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number102525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: