Healthcare Provider Details

I. General information

NPI: 1255982724
Provider Name (Legal Business Name): F AWADALLA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27800 MEDICAL CENTER RD STE 220
MISSION VIEJO CA
92691-6408
US

IV. Provider business mailing address

27800 MEDICAL CENTER RD STE 220
MISSION VIEJO CA
92691-6408
US

V. Phone/Fax

Practice location:
  • Phone: 949-545-6605
  • Fax: 949-326-7509
Mailing address:
  • Phone: 949-545-6605
  • Fax: 949-326-7509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALAN VALDES
Title or Position: COO
Credential:
Phone: 949-545-6605