Provider Demographics
NPI:1720059413
Name:AWAN, TAMSEELA T (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMSEELA
Middle Name:T
Last Name:AWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAMSEELA
Other - Middle Name:
Other - Last Name:BASHIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3102 E. HIGHLAND AVENUE
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:PATTON
Mailing Address - State:CA
Mailing Address - Zip Code:92369
Mailing Address - Country:US
Mailing Address - Phone:909-425-7000
Mailing Address - Fax:909-886-1798
Practice Address - Street 1:3102 E. HIGHLAND AVENUE
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:PATTON
Practice Address - State:CA
Practice Address - Zip Code:92369
Practice Address - Country:US
Practice Address - Phone:909-425-7000
Practice Address - Fax:909-886-1798
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51379207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C513790Medicaid
G62771Medicare UPIN
CA00C513790Medicare PIN