Provider Demographics
NPI:1225041148
Name:HAJJ, BRENDA (PA-C)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:HAJJ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-8383
Mailing Address - Fax:956-362-8382
Practice Address - Street 1:1601 E SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-5260
Practice Address - Country:US
Practice Address - Phone:956-362-8383
Practice Address - Fax:956-362-8382
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04907207Q00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184319504Medicaid
TXPA LICENSEOtherPA04907
TX184319503Medicaid