Healthcare Provider Details

I. General information

NPI: 1992722995
Provider Name (Legal Business Name): ALI MOHAMAD AWADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11633 HAWTHORNE BLVD SUITE 100
HAWTHORNE CA
90250-2321
US

IV. Provider business mailing address

1435 E SYCAMORE AVE
EL SEGUNDO CA
90245
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:
Title or Position:
Credential:
Phone: