Provider Demographics
NPI:1952500696
Name:MOAMMAR, MAHMOUD QASEM (MD)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:QASEM
Last Name:MOAMMAR
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 1:845 W LA VETA AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3930
Mailing Address - Country:US
Mailing Address - Phone:714-289-6552
Mailing Address - Fax:
Practice Address - Street 1:845 W LA VETA AVE STE 108
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3930
Practice Address - Country:US
Practice Address - Phone:714-289-6552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42606207RP1001X
CAC170981207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease