Provider Demographics
NPI:1558717165
Name:ODETTE R TAWADROUS MEDICAL CLINIC INC.
Entity Type:Organization
Organization Name:ODETTE R TAWADROUS MEDICAL CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ODETTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAWADROUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-223-1429
Mailing Address - Street 1:PO BOX 1018
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-1018
Mailing Address - Country:US
Mailing Address - Phone:310-223-1429
Mailing Address - Fax:310-223-1432
Practice Address - Street 1:3625 MARTIN LUTHER KING JR BLVD STE 10
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3509
Practice Address - Country:US
Practice Address - Phone:310-223-1429
Practice Address - Fax:310-223-1432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty