Healthcare Provider Details

I. General information

NPI: 1104740455
Provider Name (Legal Business Name): ANDREW AWADALLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 N HARBOR BLVD STE B
FULLERTON CA
92832-1362
US

IV. Provider business mailing address

14618 HELWIG AVE
NORWALK CA
90650-6020
US

V. Phone/Fax

Practice location:
  • Phone: 714-870-8478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: