Provider Demographics
NPI:1619321098
Name:AL SHAWWAF, AHMED MALIK SAFAA (MD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:MALIK SAFAA
Last Name:AL SHAWWAF
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 1:15349 CRESTVIEW CT
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2238
Mailing Address - Country:US
Mailing Address - Phone:619-593-3007
Mailing Address - Fax:
Practice Address - Street 1:330 S MAGNOLIA AVE STE 101
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-5221
Practice Address - Country:US
Practice Address - Phone:619-593-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA172928207R00000X, 208M00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine