Provider Demographics
NPI:1295181543
Name:CHARESTAN, AMMAR (MD)
Entity type:Individual
Prefix:
First Name:AMMAR
Middle Name:
Last Name:CHARESTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AMMAR
Other - Middle Name:ABDULMASSIH
Other - Last Name:CHARESTAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1320 LORNA AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-7570
Mailing Address - Country:US
Mailing Address - Phone:310-910-2169
Mailing Address - Fax:
Practice Address - Street 1:300 FIR ST FL 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2393
Practice Address - Country:US
Practice Address - Phone:619-446-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301500313207Q00000X
CAA166970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine