Basic Information
| Provider Information | |||||||||
| NPI: | 1073138608 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMARI MEDICAL CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 W MINERAL KING AVE | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932916237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595927300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 W MINERAL KING AVE | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932916237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596242000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2020 | ||||||||
| LastUpdateDate: | 07/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | AMARI | ||||||||
| AuthorizedOfficialFirstName: | AHMED | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 7206212829 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | FA8775958 | 01 | CA | DEA | OTHER |