Healthcare Provider Details

I. General information

NPI: 1992918916
Provider Name (Legal Business Name): FAWAZ SAEED OMAR AL AMMARY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BLDG 29
ORANGE CA
92868-3201
US

IV. Provider business mailing address

333 CITY BLVD W STE 400
ORANGE CA
92868-2994
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7002
  • Fax: 714-456-2949
Mailing address:
  • Phone: 714-456-5142
  • Fax: 714-456-6034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6287
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD433229
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35 . 090396
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA99785
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberDR.0048953
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35 . 090396
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD78764
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: