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General NPI Number Information
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NPI Number | 1558717165
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Entity Type | Organization
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Legal Business Name | ODETTE R TAWADROUS MEDICAL CLINIC INC.
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Dates
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Enumeration Date | 05/12/2016
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 3625 MARTIN LUTHER KING JR BLVD STE 10
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City | LYNWOOD
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State | CA
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Zip | 90262-3509
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Country | US
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Telephone | 310-223-1429
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Fax | 310-223-1432
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Provider Business Mailing Address
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Address Line | PO BOX 1018
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City | ARTESIA
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State | CA
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Zip | 90702-1018
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Country | US
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Telephone | 310-223-1429
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Fax | 310-223-1432
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ODETTE R TAWADROUS
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Credential | M.D.
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Telephone | 310-223-1429
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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 |
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License Number State |
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