Provider Demographics
NPI:1922060086
Name:FADEEL, OMAR OTHMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:OTHMAN
Last Name:FADEEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1746
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92822-1746
Mailing Address - Country:US
Mailing Address - Phone:714-827-6625
Mailing Address - Fax:714-827-9726
Practice Address - Street 1:6900 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4148
Practice Address - Country:US
Practice Address - Phone:714-880-3801
Practice Address - Fax:714-522-7328
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A445221Medicaid
CAC50182Medicare UPIN