Healthcare Provider Details

I. General information

NPI: 1689166977
Provider Name (Legal Business Name): FAUZI NAJAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3490 PALM AVE
SAN DIEGO CA
92154-1664
US

IV. Provider business mailing address

3490 PALM AVE
SAN DIEGO CA
92154-1664
US

V. Phone/Fax

Practice location:
  • Phone: 619-423-5616
  • Fax: 618-423-5684
Mailing address:
  • Phone: 619-423-5616
  • Fax: 619-423-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA174894
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA174894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: