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General NPI Number Information
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NPI Number | 1053733543
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Entity Type | Individual
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Provider Name | SALLY AMMAR
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Gender | Female
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Dates
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Enumeration Date | 01/17/2014
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 714 AVALON BLVD
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City | WILMINGTON
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State | CA
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Zip | 90744
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Country | US
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Telephone | 310-522-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 468 N CAMDEN DR # 200
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4507
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Country | US
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Telephone | 310-292-9292
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 51345
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License Number State | CA
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