MEDICARE: MR. ALI MOHAMAD AWADA 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	208000000X	Pediatrics Physician	A76844	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00A768440	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1992722995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALI MOHAMAD AWADA MD

Provider Business Mailing Address
First Line	:	1435 E SYCAMORE AVE
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245
Country	:	US
Telephone Number	:	310-355-0054
Fax Number	:	310-355-0293

Provider Business Practice Location Address
First Line	:	11633 HAWTHORNE BLVD
Second Line	:	SUITE 100
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-2321
Country	:	US
Telephone Number	:	310-355-0054
Fax Number	:	310-355-0293

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

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	07/26/2007

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