Provider Demographics
NPI:1376543785
Name:EL-HAJJAOUI, ZIAD R (MD)
Entity Type:Individual
Prefix:
First Name:ZIAD
Middle Name:R
Last Name:EL-HAJJAOUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17095 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6004
Mailing Address - Country:US
Mailing Address - Phone:760-948-6606
Mailing Address - Fax:760-951-1609
Practice Address - Street 1:17095 MAIN ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6004
Practice Address - Country:US
Practice Address - Phone:760-948-6606
Practice Address - Fax:760-951-1609
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A487510Medicaid
CACE7126Medicare PIN
F14822Medicare UPIN
CA00A487510Medicare PIN
CAET421YMedicare PIN