MEDICARE: DR. MARK AWAD MD

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
1	207L00000X	Anesthesiology Physician	A122123	CA

General Provider Information

NPI Number	:	1841582673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK AWAD MD

Provider Business Mailing Address
First Line	:	351 WINDEMERE LN
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-2079
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 LONG BEACH BLVD STE 120
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3972
Country	:	US
Telephone Number	:	562-989-1200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2011
Last Update Date	:	12/03/2021

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