Healthcare Provider Details

I. General information

NPI: 1851460950
Provider Name (Legal Business Name): NEAL M AMMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N PROSPECT AVE STE 302
REDONDO BEACH CA
90277-3041
US

IV. Provider business mailing address

944 5TH ST UNIT 104
SANTA MONICA CA
90403-2690
US

V. Phone/Fax

Practice location:
  • Phone: 310-798-1515
  • Fax: 310-798-3131
Mailing address:
  • Phone: 201-852-5980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA92792
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA92792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: