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NPI Code Detail

MEDICARE: MR. MARK ANWULI AWANYAI JR. NP

MEDICARE: MR. MARK ANWULI AWANYAI JR. NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse95100194CA
2363LP0808XPsychiatric/Mental Health Nurse Practitioner95037463CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
195037463OTHERCAFURNISHINGNUMBER

General Provider Information

NPI Number : 1356056030
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK ANWULI AWANYAI JR. NP
Provider Business Mailing Address
First Line : 5603 CARFAX AVE
Second Line :
City : LAKEWOOD
State : CA
Zip : 90713-1253
Country : US
Telephone Number : 562-378-3798
Fax Number : 562-512-4871
Provider Business Practice Location Address
First Line : 5603 CARFAX AVE
Second Line :
City : LAKEWOOD
State : CA
Zip : 90713-1253
Country : US
Telephone Number : 562-378-3798
Fax Number : 562-512-4871
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2023
Last Update Date : 11/13/2025

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