Provider Demographics
NPI:1043025018
Name:AWADALLAH, MUHAMAD
Entity type:Individual
Prefix:
First Name:MUHAMAD
Middle Name:
Last Name:AWADALLAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 W EL SEGUNDO BLVD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-4253
Mailing Address - Country:US
Mailing Address - Phone:310-321-2195
Mailing Address - Fax:
Practice Address - Street 1:4747 W EL SEGUNDO BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4253
Practice Address - Country:US
Practice Address - Phone:310-321-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver