Provider Demographics
NPI:1790971422
Name:MAWAS, ISAM (MD)
Entity Type:Individual
Prefix:
First Name:ISAM
Middle Name:
Last Name:MAWAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9808 VENICE BLVD STE 603
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-6819
Mailing Address - Country:US
Mailing Address - Phone:310-730-8606
Mailing Address - Fax:318-973-2420
Practice Address - Street 1:3831 HUGHES AVE STE 604
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6848
Practice Address - Country:US
Practice Address - Phone:310-730-8606
Practice Address - Fax:318-973-2420
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2022-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA98516207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty