Healthcare Provider Details

I. General information

NPI: 1144135559
Provider Name (Legal Business Name): AWH CA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11940 FOOTHILL BLVD STE 208
RANCHO CUCAMONGA CA
91739-9376
US

IV. Provider business mailing address

10501 W GOWAN RD STE 200
LAS VEGAS NV
89129-6602
US

V. Phone/Fax

Practice location:
  • Phone: 725-204-6055
  • Fax:
Mailing address:
  • Phone: 725-204-6055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HANNAH SIABI
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 725-204-6055