Provider Demographics
NPI:1649795360
Name:ISAM MAWAS MD INC
Entity type:Organization
Organization Name:ISAM MAWAS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAWAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-859-4486
Mailing Address - Street 1:3831 HUGHES AVE STE 604
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-6848
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98516207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty