Healthcare Provider Details

I. General information

NPI: 1710832043
Provider Name (Legal Business Name): AHMAD MAREI NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N TUSTIN AVE
SANTA ANA CA
92705-3528
US

IV. Provider business mailing address

999 N TUSTIN AVE
SANTA ANA CA
92705-3528
US

V. Phone/Fax

Practice location:
  • Phone: 714-617-2626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95038203
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95038203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: