MEDICARE: DR. ANAS M ALJAMMAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A178322	CA

General Provider Information

NPI Number	:	1437611464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANAS M ALJAMMAL MD

Provider Business Mailing Address
First Line	:	370 OCEAN AVE
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-2322
Country	:	US
Telephone Number	:	949-557-0610
Fax Number	:	949-557-0611

Provider Business Practice Location Address
First Line	:	370 OCEAN AVE
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-2322
Country	:	US
Telephone Number	:	949-557-0610
Fax Number	:	949-557-0611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2019
Last Update Date	:	11/05/2024

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