Healthcare Provider Details

I. General information

NPI: 1770793853
Provider Name (Legal Business Name): MUNIR M UWAYDAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S MACLAY AVE
SAN FERNANDO CA
91340-3603
US

IV. Provider business mailing address

2800 NEILSON WAY # 116
SANTA MONICA CA
90405-4025
US

V. Phone/Fax

Practice location:
  • Phone: 818-700-1250
  • Fax: 818-700-1045
Mailing address:
  • Phone: 310-399-7824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberA62059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: