Provider Demographics
NPI:1356056030
Name:AWANYAI, MARK ANWULI JR (RN)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANWULI
Last Name:AWANYAI
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 CARFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1253
Mailing Address - Country:US
Mailing Address - Phone:562-981-4193
Mailing Address - Fax:
Practice Address - Street 1:5603 CARFAX AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1253
Practice Address - Country:US
Practice Address - Phone:562-981-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95100194163W00000X
CA95037463363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse