Healthcare Provider Details

I. General information

NPI: 1215641709
Provider Name (Legal Business Name): MARIUM AWAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 JACKSON ST
RIVERSIDE CA
92503-3919
US

IV. Provider business mailing address

15 SAGECREST
FOOTHILL RANCH CA
92610-2425
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-2211
  • Fax:
Mailing address:
  • Phone: 94-963-0667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71508
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number75958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: