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General NPI Number Information
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NPI Number | 1164795498
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Entity Type | Individual
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Provider Name | ALAN AWDISHO D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 875 EL CAJON BLVD
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City | EL CAJON
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State | CA
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Zip | 92020-5714
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Country | US
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Telephone | 619-662-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 PRECISION PARK LN
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City | SAN DIEGO
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State | CA
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Zip | 92173-1345
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Country | US
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Telephone | 619-662-4100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 006688
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License Number State | AZ
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