Healthcare Provider Details

I. General information

NPI: 1174435671
Provider Name (Legal Business Name): EMMANUEL AWDISHU, MD, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27403 YNEZ RD STE 108
TEMECULA CA
92591-4619
US

IV. Provider business mailing address

27403 YNEZ RD STE 108
TEMECULA CA
92591-4619
US

V. Phone/Fax

Practice location:
  • Phone: 951-750-7888
  • Fax:
Mailing address:
  • Phone:
  • 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: DR. EMMANUEL AWDISHU
Title or Position: MD/CEO
Credential:
Phone: 941-718-8837