Healthcare Provider Details

I. General information

NPI: 1629510235
Provider Name (Legal Business Name): LAWRENCE AWAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4776 STETSON RD
CLOVIS CA
93619-9555
US

IV. Provider business mailing address

4776 STETSON RD
CLOVIS CA
93619-9555
US

V. Phone/Fax

Practice location:
  • Phone: 559-323-1296
  • Fax: 559-323-1296
Mailing address:
  • Phone: 559-323-1296
  • Fax: 559-323-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberC41470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: