Provider Demographics
NPI:1275983843
Name:HAGGENJOS, SHAWNA
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:HAGGENJOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 NARRAGANSETT AVE
Mailing Address - Street 2:33
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3049
Mailing Address - Country:US
Mailing Address - Phone:808-220-0492
Mailing Address - Fax:
Practice Address - Street 1:5116 NARRAGANSETT AVE
Practice Address - Street 2:33
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-3049
Practice Address - Country:US
Practice Address - Phone:808-220-0492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant