Healthcare Provider Details

I. General information

NPI: 1356531297
Provider Name (Legal Business Name): ALI M. AWADA M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11633 HAWTHORNE BLVD 100
HAWTHORNE CA
90250-2321
US

IV. Provider business mailing address

11633 HAWTHORNE BLVD 100
HAWTHORNE CA
90250-2321
US

V. Phone/Fax

Practice location:
  • Phone: 310-355-0054
  • Fax: 310-355-0293
Mailing address:
  • Phone: 310-355-0054
  • Fax: 310-355-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA76844
License Number StateCA

VIII. Authorized Official

Name: DR. ALI MOHAMAD AWADA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-355-0054