Provider Demographics
NPI:1770362527
Name:ABU-AWWAD, FADI
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:
Last Name:ABU-AWWAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18433 HATTERAS ST UNIT 207
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1942
Mailing Address - Country:US
Mailing Address - Phone:778-549-1807
Mailing Address - Fax:
Practice Address - Street 1:12833 VENTURA BLVD UNIT 153
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2368
Practice Address - Country:US
Practice Address - Phone:323-826-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor