Healthcare Provider Details

I. General information

NPI: 1982099115
Provider Name (Legal Business Name): MICHAEL AMMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12630 MONTE VISTA RD STE 104
POWAY CA
92064-2526
US

IV. Provider business mailing address

12630 MONTE VISTA RD STE 104
POWAY CA
92064-2526
US

V. Phone/Fax

Practice location:
  • Phone: 858-451-1911
  • Fax:
Mailing address:
  • Phone: 204-441-6382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD466821
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberA172267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: