Basic Information
| Provider Information | |||||||||
| NPI: | 1356737191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HIJAZI | ||||||||
| FirstName: | HUSSEIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91275 66TH AVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | MECCA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922546515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603961249 | ||||||||
| FaxNumber: | 7603961253 | ||||||||
| Practice Location | |||||||||
| Address1: | 91275 66TH AVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | MECCA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922546515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603961249 | ||||||||
| FaxNumber: | 7603961253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2015 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D86132 | MD | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MT212202 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A169664 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.