Healthcare Provider Details

I. General information

NPI: 1760475701
Provider Name (Legal Business Name): AMER EMILE JABARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W LA VETA AVE STE 107
ORANGE CA
92868-4447
US

IV. Provider business mailing address

705 W LA VETA AVE STE 107
ORANGE CA
92868-4447
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-4901
  • Fax: 714-771-5389
Mailing address:
  • Phone: 714-639-4901
  • Fax: 714-771-5389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG069806
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: