Provider Demographics
NPI:1205191038
Name:AWAN, NASIR
Entity Type:Individual
Prefix:
First Name:NASIR
Middle Name:
Last Name:AWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NASIR
Other - Middle Name:
Other - Last Name:AWAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7816 YORKTOWN PLACE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045
Mailing Address - Country:US
Mailing Address - Phone:310-902-7741
Mailing Address - Fax:310-568-0547
Practice Address - Street 1:7816 YORKTOWN PLACE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045
Practice Address - Country:US
Practice Address - Phone:310-902-7741
Practice Address - Fax:310-568-0547
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0000450042-00024332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier