Provider Demographics
NPI:1346849007
Name:HAWARA, JANESSA J (PA-C)
Entity Type:Individual
Prefix:
First Name:JANESSA
Middle Name:J
Last Name:HAWARA
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 1:2243 N NIAGARA ST APT B
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-3281
Mailing Address - Country:US
Mailing Address - Phone:818-967-9809
Mailing Address - Fax:
Practice Address - Street 1:12100 VALLEY BLVD STE 109A
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3161
Practice Address - Country:US
Practice Address - Phone:626-575-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA58619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant