Provider Demographics
NPI:1306212543
Name:MOTIWALA, HAJRA (PA-C)
Entity Type:Individual
Prefix:
First Name:HAJRA
Middle Name:
Last Name:MOTIWALA
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 1:1110 COTTONWOOD LN STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6121
Mailing Address - Country:US
Mailing Address - Phone:844-789-7246
Mailing Address - Fax:888-880-9323
Practice Address - Street 1:1110 COTTONWOOD LN STE 110
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6121
Practice Address - Country:US
Practice Address - Phone:844-789-7246
Practice Address - Fax:888-880-9323
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2826363A00000X
MSPA00290363A00000X
TXPA12735363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant