Provider Demographics
NPI:1497862254
Name:AL-HARIRI, AMR (MD)
Entity Type:Individual
Prefix:
First Name:AMR
Middle Name:
Last Name:AL-HARIRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE STE 900
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1220
Mailing Address - Country:US
Mailing Address - Phone:858-626-4604
Mailing Address - Fax:858-626-4604
Practice Address - Street 1:1050 LAS TABLAS RD
Practice Address - Street 2:SUITE 10
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9729
Practice Address - Country:US
Practice Address - Phone:805-434-2482
Practice Address - Fax:805-456-7702
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54396207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ59625YOtherBLUE SHIELD PIN
CAZZZ59625YOtherBLUE SHIELD PIN
CAG09525Medicare UPIN