Provider Demographics
NPI:1669608790
Name:AWADALLA, FARAH C (MD)
Entity type:Individual
Prefix:DR
First Name:FARAH
Middle Name:C
Last Name:AWADALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BOBBY
Other - Middle Name:
Other - Last Name:AWADALLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:27800 MEDICAL CENTER RD STE 220
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6408
Mailing Address - Country:US
Mailing Address - Phone:949-545-6605
Mailing Address - Fax:949-326-7509
Practice Address - Street 1:27800 MEDICAL CENTER RD STE 220
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6408
Practice Address - Country:US
Practice Address - Phone:949-545-6605
Practice Address - Fax:949-326-7509
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125067207ND0101X, 207NP0225X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology