=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356531297
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALI M. AWADA M.D. INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2007
-----------------------------------------------------
Last Update Date | 07/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11633 HAWTHORNE BLVD 100
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90250-2321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-355-0054
-----------------------------------------------------
Fax | 310-355-0293
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11633 HAWTHORNE BLVD 100
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90250-2321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-355-0054
-----------------------------------------------------
Fax | 310-355-0293
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALI MOHAMAD AWADA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 310-355-0054
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A76844
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------